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Ignoring half of humanity?

March 11, 2019

Recently I was reviewing my will, and what lawyers call the ancillary documents dealing with end of life matters. Some of those arise from a somber fact of biology, that it is one’s brain, functioning normally, that gives rise to the person one is. And that disease often steals that function away, in parts or entirely, even while the rest of the body continues on.

Medical practice is constrained by law. And our law has evolved over centuries, holding mostly folk notions of life and death, accumulated over that time. It takes some effort and planning if one wants decisions made more rationally at the end of one’s own life. A discussion with one of those lawyers highlighted that it is especially physicians who seem intent on not prolonging biological life, once their mental life has suffered too great loss, or even has gone entirely. They likely see enough family members of patients, still acting as if their loved one is there, and making medical choices in that hope, when little is left other than the familiar body and the familiar face and the heart kept beating, with the aid of technology.

Tradition and ideology and lack of biological knowledge play a large role in how people see both ends of life. I asked one respondent recently how early he wanted to view the zygote as a person. And he answered, from fertilization.

HumanBlastocystConsider what that would mean. Natural fertilization takes place in a woman’s fallopian tube. The woman is not yet pregnant, since that early zygote is in her, but not yet attached. In the several days after sperm fertilizes egg, that zygote will undergo quite a bit of cell division, eventually forming into a hollow ball called a blastocyst. At the same time, it is descending the fallopian tube. Entering the uterus, if the blastocyst implants there, the woman then is pregnant.

Or not. Only half of blastocysts implant. The rest, whether through bad timing in their descent or biological mishap or just luck, pass out of the uterus and then out the vagina. Unnoticed. At that point in its development, the blastocyst is a tenth of a millimeter in diameter. About the width of human hair. So it is easy not to notice.

If those blastocysts are viewed as persons, that failure to implant is the single greatest cause of human death. By itself, equaling all other causes combined. On average, a woman who has borne children will have lost as many of these. Those who actually viewed that as a person’s demise would take all sorts of measures in response. Couples would seek kits to test for the “remains” of these “lost children,” so that they could be named and mourned and their deaths given whatever ceremony the parents deem appropriate. The religious would say prayers for these “lost souls.” The charitable would create foundations to research preventives for this “terrible tragedy.” Filmmakers would produce documentaries on that most dangerous six inches “people” travel after conception. Medical schools would make this a research priority. It is, after all, half of humanity we’re discussing.

If they are viewed as persons.

I am not suggesting that anyone take such measures. How preposterous! But I think it is preposterous to view blastocysts as persons. What I describe briefly above is a small part of what people would do if they took that view seriously. The reality is that the “pro-lifers” who are eager to claim there is a person from conception treat the not-yet-implanted blastocyst as cavalierly as the rest of us. With a telling exception, that I will note below. Their lack of concern about that “half of humanity” belies their claimed moral beliefs. And none of the excuses sometimes offered for that hold water. Some will explain that failure to implant is natural. But so are cystic fibrosis and childhood leukemia. Yet we mourn children who succumb to those and expend significant resources on researching and treating such diseases. Even though they strike far, far fewer. Some will explain that “pro-lifers” are focused on stopping abortion. But to the exclusion of everything else? Do they not want even to know when they have “lost a child” of their own? Many may honestly explain they just didn’t realize this aspect of human biology. In which case they are due for a serious rethink, first asking themselves how they became so certain in tying their moral outlook to biological processes about which they’re so ignorant?

I know only one reasonable explanation for dismissing the blastocysts that fail to implant, rather than treating them as a half of humanity tragically lost. Quite simply, at that stage, the blastocyst is not yet capable of any of the cognitive features that characterize a person. They have no neurological development whatsoever. They are indeed biological organisms of our species. But still at a point where they are mere biology. So we don’t mourn their demise or worry about preventing it. They easily are created by normally fertile couples. So much so that the half that are lost are not much hindrance to having children. They disappear without notice, and soon enough, there is another. For those who have difficulty achieving pregnancy naturally, fertility specialists will create zygotes in vitro for artificial implantation. And they do so, knowing only a few of those so created will be used, possibly to develop into fetuses and then infants and then children. Those not used often are taken out with the trash. That concerns me not in the least. And shouldn’t concern either any couple working with a fertility specialist.

Which brings us to the one time “pro-lifers” care about blastocysts not yet implanted. They sometimes make a stir about the few that are created in vitro. And they care about the blastocyst once it implants and the woman is pregnant. It is tempting to observe that they start caring only when caring becomes a lever for limiting other people’s reproductive choices.

Any rational discussion of what counts as a person centers on the cognitive faculties that make us who we are. Those that give us a sense of self, that let us hold a notion of a personal history, that enable our social interaction and reflection on that. That also is why we have some concern for how we treat some of the smarter animals, like elephants and chimpanzees. When we see that they remember past companions and that they mourn their dead family members, we recognize in them, to some degree, the kind of things that make us who we are.

Biology being messy, there never will be crisp moral categories. We will erect ethical fences over landscape of endless shades of gray. That is one of the uses to which we put our cognitive faculties. Human development of those faculties is gradual and complex. Human loss of those is varied and complex. (If you haven’t read The Man Who Mistook His Wife for a Hat, do so.) Despite their complexities, our partial understanding, and their sometimes fragmentation, it is the development and loss of those faculties that begin and end the persons we are.

Ob disclaimer: I am an organ donor. The State of Texas makes that ancillary document easy. Once my brain is dead, I am happy for the other parts of my body to be put to good use for others’ sake. Even if technology can still keep my heart beating and lungs breathing. Those aren’t the features that define me.

Update: Since originally posting, I stumbled across some interesting research on zygote development into blastocyte. (Cite.)

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