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Medical Students /Paediatric notes
When does Human Life Begins?
Dr Alex Tang
In Genesis, the first book of the Christian Bible, it is recorded that God
created humans out of the dust of the earth. He made the first man, named Adam
and breathed life into him (Genesis 2:7). This implied a process. First, God
formed Adam out of the dust of the ground. He only became a living being after
God breathed the breath of life into him. Then God created woman, Eve, out of a
rib from Adam, the first recorded case of plastic and reconstructive surgery
(Genesis 2:22). In the case of Adam and Eve, we know when life began and when
they became human beings and persons. But the Bible does not give further
information on when the rest of humankind become human beings and persons. The
Bible records that Adam had sexual intercourse with Eve and Eve became pregnant.
After a term of pregnancy, Cain was born. Nowhere in the Bible is it stated when
human life begins.
This fact is important when we discuss bioethical issues of abortion,
reproductive technologies, cloning and stem cell research. Central to many of
the arguments and disagreements concerning these issues is the question, “When
does human life begin?” The debate has divided Christians from the various
traditions (Roman Catholic, Orthodox and Protestant) because of the silence of
the Bible on this important piece of information. It also makes it difficult to
dialogue with people from other traditions and beliefs. It is especially
relevant as science and technology intrude into our sexual reproductive
processes.
The Biology of Sex
During a woman’s reproductive period from puberty (menarche) to menopause, she
produces a few hundred thousands eggs or ovum which are released from her
ovaries into her fallopian tubes during the fertile phase of her monthly
menstruate cycle. During sexual intercourse, a male ejaculates millions of
spermatozoa into a woman’s vagina. These race upwards into the fallopian tubes.
There these millions of spermatozoa meet a single egg. Fertilisation is said to
have taken place when a single spermatozoa penetrates into the egg or ovum. Once
a spermatozoon has penetrated into an ovum, a barrier is immediately built up to
prevent other spermatozoa from entering. In the egg, there is fusing of the DNA
genetic materials resulting in the forming of an embryo or fertilised ovum or
blastomere. This begins to divide by a process of mitosis where it begins to
split down the middle and two identical cells are formed. This process is
replicated continuously. In the meantime, the embryo moves down the fallopian
tubes into the uterus. It takes about four to seven days before it reaches the
uterus. By then, it will compose of about 100 cells and is known as a blastocyte
or ‘pre-implantation embryo’. This blastocyte has to implant in the uterine wall
and produce a secretion, human chorionic gonadotrophin (hCG) which makes the
uterine walls favourable to further growth and prevent menstruation. Failure to
implant in the uterine wall will result in the blastocyte being washed out of
the uterus and die. It is estimated that 40 to 70 percent of all
‘pre-implantation embryos’ are discarded without the woman being aware of it.
When does Human Life Begins?
Conception
The Roman Catholic Church, the Orthodox Church and some of the Protestant
denominations regard conception as the point when the spermatozoa penetrates the
ovum and fertilises it. To them, conception is when human life begins.
Conception is when the soul enters the cell or ensoulment has occurred. The
philosopher Aristotle believed that at conception the future child is endowed
with a principle of only vegetative life. This is exchanged after a few days for
an animal soul. The animal soul is succeeded by a rational soul much later. His
followers taught that a male child receives his rational soul on the fortieth
day. The female child receives her rational soul on the eightieth day. This
belief was widely accepted by the ancient world for many centuries. In the
fourth century, Gregory of Nyssa, who was well educated in Greek teaching,
advocated the view that at the time of conception, the embryo is given a life
principle (soul) and begins to live a distinct individual life. However Thomas
Aquinas, the great Dominican theologian reverted to the Aristotle teaching that
a male was given a soul after 40 days and the female after 80 days. This was
accepted by the church and later became widely accepted as a church tradition
until 1875. In 1875, the German embryologist Oskar Hertwig discovered that the
important event in fertilization was the fusion of the spermatozoa and the ovum
(egg). That year, the Sacred Congregation for the Doctrine of Faith in Rome
declared that human being exist and became ‘ensouled’ at the moment of
spermatozoa entering the ovum. In 1987, they modified their view by declaring
that human life begins not at the moment of penetration of the ovum by the
spermatozoa but at the moment of the fusion of the male and female genetic
materials (nuclei). Modern science has discovered that there is a time lapse of
22 hours between the moment the spermatozoa penetrate the ovum wall and the
fusion of the genetic materials.
The late Pope John Paul II reaffirmed the Roman Catholic tradition that life
begins at conception when he wrote: “When a unique set of human genetic
instruction is present, a person is present.” In his attempt to modernise a
church tradition, the late pope implied that the presence of a complete set of
human DNA makes a cell a human person. To modern scientists, it may not make
sense. They may retort that all our skin cells have complete sets of human DNA
and we lose millions of skin cells a day! Is each cell then a person? Having a
complete set of human DNA may not make a person as in the case of a teratoma. A
teratoma is a fertilised ovum mutated into a tumour. There are differentiations
of tissues in a teratoma though in a chaotic manner. When we cut open a
teratoma, we may find hair, mixed with tooth and other organs but a human being
was never formed. All the genetic information was present but the development
went haywire. Another point to be considered is that 40 to 70 percent of
fertilised eggs die when they fail to implant in the womb. If the presence of a
complete set of DNA defines a human person, then one would have to say that the
majority of human beings were never born or lived no longer than a week.
Professor John Guillebaud from the University of College, London has suggested
that conception be seen as a process. He believes conception has two components:
fertilisation and implantation. Fertilisation without implantation has zero
survival rate. Fertilisation and implantation has about 80 percent chance of
making it to term. Hence Professor Guillebaud would consider conception to have
taken place only when a fertilised ovum implants in a uterine wall. Conception,
according to him, would not have taken place if the spermatozoa penetrated the
ovum and fertilised it but was not implanted, as in spontaneous abortions or
fertilisation in a test tube. On the other hand, Professor Ramsey, a noted
Protestant ethicist, believes a zygote is a human being i.e. human life begins
at conception. Professor Ramsey did not go into the technical details.
Fourteen Days
Many in the scientific community believe that human life begins 14 days after
conception. Implantation begins at day five and completes by day nine. By day
14, the cells of the embryo begins to specialise so that the embryo has a top,
bottom, front and back. A primitive streak is formed which will develop into the
spinal cord and nervous system. Other cells begin to separate into foetus,
placenta and other supportive tissues.
At 14 days, the possibility of twinning recedes. Twins are formed when the
embryo splits into two, each with equal and identical genetic materials. Both
embryos continue their development. These are identical twins because they are
from one embryo. They share one placenta. Non-identical twins happen when two
ova are fertilised and the two embryos are implanted at almost the same time.
They develop independently of each other. Triplets, quadruplets and so forth are
similarly formed.
Some would regard this as an important fact. If one were thinking in terms of
souls, then would an embryo that is destined to split and become twins be given
two souls at conception? Could two souls coexist in one embryo? If at
conception, one soul were given, what would happen when the embryo splits into
two when twinning occurs? Another observation is that prior to 14 days, two
embryos can fuse and subsequently develop normally but with four sets of genetic
information.
In the United Kingdom, an ethics committee led by Dame Mary Warnock, a
philosopher came to the conclusion that it is not unethical to create and
experiment on embryos as long as it does not occur fourteen days after
fertilisation. The Warnock Committee’s recommendation served as the basis of The
Human Fertilisation and Embryology Authority Act passed in the United Kingdom in
1990. This Act governs IVF (In Vitro Fertilisation) and the treatment of
embryos. Experimentation of embryos was allowed under the Act until fourteen
days after fertilisation.
The 14-day mark is the choice of the Embryo Research Panel of the National
Institute of Health (1994) in the USA and of the Donaldson Report in UK. Many
other research institutes also follow similar definitions that human life begins
at 14 days with the formation of the primitive streak and the possibility of
twinning recedes.
Twenty Eight Days
The formation of all body systems and organs is complete after 28 days. The
embryo is about two mm long. During subsequent growth, these organs will
increase in size and functions. The embryo can now be considered ‘formed’. A
human body or nephesh may be said to be present. In the early and medieval
church, the consensus among theologians was that God would give a soul at the
point when the body is fully ‘formed’ at the womb. This is known as soul
creation. Another school of thought called traducianism taught that a soul is
inherited from one’s parents and will be fully formed when there is a formed
body. One can only be a human being if one has a body and a soul. This is
obviously different from the beliefs of the early Church Fathers that a life
principle (soul) is given at conception. Both soul creation and traducianism
reason that one needs to have a body to have a soul. The distinction is between
‘formed’ and ‘unformed’. Those who taught this include Lactanius, Jerome,
Augustine, Cyril of Alexandria and Thomas Aquinas.
Forty Days
Aristotle wrote that the male embryo develops a human soul about 40 days after
conception, whereas a female embryo acquires its soul 80 days after conception.
One author has suggested that the early church was influenced by this ‘delayed
ensoulment’ principle and allowed abortion up to 90 days.
At 40 days, primitive undeveloped brain waves can be detected. High resolution
ultrasound done on the foetus at this stage shows incredible details—the foetus
begins to look like a baby. In the Jewish rabbinic understanding of the Talmud
and subsequent teachings, a developing foetus before 40 days is ‘like water’. It
is only worthy of consideration after 40 days.
Twenty Four Weeks
About 24 weeks, the foetus becomes viable. This means that if it was delivered
prematurely, it can survive with the help of modern medical care. The World
Health Organization (WHO) defined abortion as any product of conception
delivered before 28 weeks. However, nowadays it is routine to be able to save
babies born prematurely at 24 weeks. Some medical ethicists use viability as a
measure of being human.
Twenty Six Weeks and Later
There is now viability and foetal higher function becomes operational. Brain
wave patterns show waking and sleeping stages. To some people, this
self-awareness is what makes a human being. Self-awareness is one of the
important criterions of personhood. Carl Sagan believed that the ability to
think is what makes us human.
First Breath at Birth
The Jewish rabbinic commentary regards the foetus to be part of the mother’s
body and it is only at the moment when the head or the greater part of the
breech is delivered that the foetus becomes an individual. But it continues to
be regarded as a non-souled entity until after 30 days. Jewish children are not
named or admitted to the community until after the eighth day and for those who
die in the perinatal period (30 days), the rituals of death are not necessary.
Human Life and the Bible
The Bible did not give an answer to this most basic of question, “When does
human life begins?” Attempts have been made by various scholars to cite evidence
that God consider the fetus to be fully human by referring to Psalm 139, Job
3:11, Jeremiah 1:5 and Luke 1:39-44.
John Stott made an ingenious argument by using Psalm 139. Firstly, using verse
14, ‘for you created my inmost being; you knit me together in my mother’s womb’,
he concluded that the psalmist is already aware at his conception – creation.
Secondly, in verse 1 ‘ you have searched me’ (the past), verse 2-3, ‘ you know
when I sit and when I rise ..’ (the present) and verse 10,’your hand will guide
me, your right hand will hold me fast..’(the future).There is continuity. And
thirdly, the whole Psalm 139 spoke of communion between God and the psalmist.
John Stott concluded that these three words (creation, continuity, communion)
gave us the perspective to see that the fetus is already a human life, though
not yet mature have the potential of growing into the fullness of humanity. The
point he made was that the beginning of human life is found in the pre-natal
period and there is continuity from life before and life after birth. One must
be aware of making inferences from a poetic genre. The Psalmist was a grown man
making observation about his life. This is the perspective of a person looking
backwards in time.
"Why did I not perish at birth, and die as I came from the womb?” Job 3:11 (NIV).
Job 3:11 is a metaphor. It sheds no light on whatsoever on the status of the
foetus Job. Again it is a retro perspective view as it is the adult Job
contemplating his circumstances.
"Before I formed you in the womb I knew you, before you were born I set you
apart; I appointed you as a prophet to the nations." Jeremiah 1:5 (NIV).
Jeremiah 1:5 is more about God calling of Jeremiah to be his prophet rather than
a statement of when Jeremiah became a human being.
Luke 1:39-44 is about when Mary and Elizabeth met, both being pregnant.
Elizabeth’s baby (John the Baptist) ‘leaped in her womb’ in respond to the
presence of Mary’s baby (Jesus). The case was made here that Luke uses the same
word brephos of an unborn child (1:41,44) as he later uses of a new-born baby
(2:12,16) and of the little ones whom people brought to Jesus to be blessed by
him (18:15). It is difficult to conceive of a principle by one Greek word. Luke
who was often careful of his words classifies them all as children. Being a
medical doctor, Luke must be aware of ‘quickening’ or when the unborn child
makes his or her first movement in the womb. The emphasis on this passage is on
the reaction of the unborn John the Baptist to the unborn Jesus.
As we have seen, these often quoted passages did not address the question, “When
does human life begins?” When proper exegesis has been done, we can only
conclude that while dealing with born and unborn child, the emphasis is on the
sovereignty of God and His interactions with human beings that were born and had
grew up to adulthood.
Human Life and Personhood
In recent years, the discussion on “when does human life begin?” has changed to
“when does a person become a person?” There are a few ethicists who think that
having the human genetic code and looking like a human being does not guarantee
that the entity is human. Being human also involves personhood. Mary Anne
Warren’s criteria for a person are consciousness, reasoning, self-motivated
activity, capacity to communicate and self-awareness. A newborn baby does not
seem to exhibit all of these characteristics. Peter Singer, Ira W. DeCamp
Professor of Bioethics, University Center for Human Values, Princeton
University, believes that personhood comes weeks after birth. A fertilised ovum
or a developing embryo in the uterus is not a person until it becomes
self-aware. According to Peter Singer, self-awareness is an important criterion
for personhood and this comes long after birth. More about personhood when we
discuss abortion in the next chapter.
Conclusion
It is obvious there is no general consensus about when human life begins among
the Christian community. There is also no consensus about when personhood begins
or even whether personhood is a prerequisite of being human, or when ensoulment
or when the soul enters an embryo. Firstly, it must be noted that the various
options discussed above are based on learned speculation. Speculations which
were widely accepted became church tradition. It must also be noted that while
these church teachings draw on the teaching of the Bible, the Bible does not
specify when exactly human life begins except for Adam and Eve. Here we must be
clear in our thinking which is theology and which is church tradition. We also
need to differentiate these from absolute truth. Theology is the study and
knowledge of God’s revelation of himself in the Bible and in his creation. We
are finite in our understanding and are limited by culture, time and language.
Hence our theology is an approximation but never the absolute truth. Only God
has the absolute truth. But as we grow in our understanding and develop new
scholarship tools, we begin to understand more. That is why theology is
constantly developing as we understand more and more of the absolute truth. Some
revelations of God of God are certain and unchangeable. One example is the
Trinity: Three Persons yet one. No amount of development of theology can add
another person to the Trinity. Another is that Jesus Christ is fully God yet
also fully human. Other areas of theology are formed and informed by our times
and culture. As we have noted above, great Church theologians like Augustine is
neo-platonic in his approach while Thomas Aquinas lean towards Aristotle’s
teachings. Church traditions are often human formulations made to meet the needs
of their times and politics. But usually once implemented, it becomes inflexible
and believers are required to follow unquestioningly. Tradition may or may not
be based on absolute truth.
Secondly, there must be room for differences of opinions since the Bible does
not specify the time of the beginning of human life. As our knowledge of human
embryology improves, we learn more of the formation of the wonderful human body.
We must realise that earlier church speculations were based on the knowledge of
human embryology of their time. One cannot help but wonder what the early Church
Fathers would do if they knew that the human foetus develops gills, tail and
other characteristics similar to other animals before developing into a form
that we are used to.
A Christian Medical Fellowship survey published in 1996 showed that of the 2,580
Christians doctors who responded, only 36 percent believed that human life had
‘full value’ at the time of fertilisation. However for the 8-week old foetus,
the figure had risen to 85 percent. This survey clearly showed that
practitioners, people who are engaged in marketplace ministries, often have
different perception of the issues involved compared with those from theological
institutions. It must be noted is that the survey was about abortion and how
Christian doctors perceive issues involved.
We must have the true humility to acknowledge that there are limits to human
knowing. In this case, we just do not know when human life begins. The
theologians may argue from Scripture but they must acknowledge that these few
passages we have alluded to do not actually tell us when human life begins.
Empirical scientific data or philosophy with a working knowledge of embryology
may arrive at a 14 days guideline. Judaism has another time frame. The simple
truth is that we just do not know. When a human life begins remains and will
always be one of the Mysteries of God.
Thirdly, in areas where the Bible is non-specific, the church has always
gravitated to a principle of least harm done. This is a notable principle and I
think this is the most relevant in our argument. If we really do not know, then
we should aggravate towards a stand that will cause the least harm. I am sure
most people will agree with this. The fundamental rule of medicine is “first do
no harm”. Therefore the stand that will do the least harm is that human life
begins at conception.
Finally, our decision on when human life begins has a decisive effect on how we
deal with the issues of abortion, use of reproductive technologies, cloning and
stem cells research. While the Bible is silent on when human life begins, it has
given us a clear mandate of loving our neighbours and helping the weak and sick.
Maybe that is precisely why the Bible is silent on when human life begins. God
may want us to use our judgment on how we can love our neighbours and help the
weak and the sick. He knows that as our scientific data increase, we need to
evaluate our works of charity instead of being fixed by a mould. The prophet
Micah wrote, “He has showed you, O man, what is good. And what does the Lord
require of you? To act justly and to love mercy and to walk humbly with your
God.”(Micah 6:8). Our decision on when human life begins must be based on
available facts, cause least harm, helpful to our neighbours, help the weak and
most of all, we must be humble. All our bioethical decisions must be made in
humility before our Creator God who has given us the power to be ‘co-creator’
with him. We recognise God as the Creator who created ex-nihilo. But we
are also called to be ‘co-creator’ with him as we ‘create’ new things from
materials in his creation. Computers, mobile phones and television did not exist
in the Garden of Eden but was ‘created’ by us using the natural physical laws
and principles of God’s creation.
Soli Deo Gloria
|posted 10 June 2006|
|updated 22 Feb 2010|
