(Based on an earlier play, Irving, "A One-Act Drama: The Early Human Embryo: 'Scientific' Myths and Scientific Facts: Implications for Ethics and Public Policy", presented to Medicine and Human Dignity, "International Bioethics Conference, 'Conceiving the Embryo'", Centre Culturel, Woluwe-St. Pierre, Brussels, Belgium; Sunday, October 20, 2002; edited November 17, 2010; emphases used to aid those unfamiliar with the scientific and bioethics terms)
"When _I_ use a word," Humpty Dumpty said in rather a scornful tone, "it means just what I choose it to mean -- neither more nor less." "The question is", said Alice, "whether you CAN make words mean so many different things." "The question is," said Humpty Dumpty, "which is to be master -- that's all."
Through the Looking-Glass, by Lewis Carroll [Charles Dodgson]
Scene: A dark meeting room somewhere in Brussels.
Characters: Chairman, Lobbyists (including Dr. "Science", Dr. Gyno, Dr. Human Embryology, Prof. Philos, Master Bioethics, Crippled Conscience, and Well-Formed Conscience); also present are, Jaded Judge, Perplexed Parliamentarians, and Narrator.
Plot: The selected committee members are meeting to debate and reach an ethical consensus on proposed legislation concerning human cloning and human embryonic stem cell research. The language of the legislation has been written by those in attendance.
The Chairman enters the dark meeting room and calls the meeting to order. All members, except Well-Formed Conscience, who is knocking politely on the other side of the heavy locked doors, are present.
Mr. Chairman: The purpose of this meeting is to listen to all relevant opinions concerning this critically important piece of legislation on human cloning and human embryonic stem cell research that we Parliamentarians have already decided to propose. Each lobbyist present will be given a full 2 minutes to present his or her suggestions for the language to be used in the legislation before we finally vote. Since the issues involved in this legislation are very technical, I would like Master Bioethics to proceed first, and to explain to the rest of us the medical facts we all need to understand accurately in order to be well-informed on these subjects. After all, the starting point for considering these technical issues is the bioethics.
Dr. Gyno: I object, Mr. Chairman. Physicians, especially ObGyn's, are the medical experts in these issues. We should proceed first.
Dr. "Science": Objection, Mr. Chairman. Physicians have medical degrees, not Ph.D. degrees. The correct starting point for considering human cloning and human embryonic stem cell research is the empirical science of mouse molecular biology and frog genetics.1
Mr. Chairman: Of course, Dr. "Science". Proceed.
Dr. "Science": Everyone would agree that we scientists already have absolute freedom of scientific inquiry; but it would be helpful if such authority were to be fully sanctioned by national legislation, and declared ethical. We only want to derive stem cells from some relatively worthless human "pre-embryos". These "pre-embryos" can be easily obtained using donated "surplus" IVF-embryos, or by creating our own by means of either sexual reproduction (e.g., IVF) or a-sexual reproduction (e.g., cloning) in the lab. Objections to this research are simply based on nothing more than the subjective opinions of scientifically illiterate religious zealots using debatable "scientific facts" who want to force their own morality on the rest of us. They actually claim that these cells are persons immediately at fertilization or cloning. Imagine that! Every scientist knows that "personhood" cannot begin until at least 14-days after fertilization.2 Right, Master Bioethics? At most, these collections of cells possess only a "reduced moral status". So there are no serious ethical problems with our proposals.
Crippled Conscience: That's right!
Prof. Philos: Not so fast, Dr. "Science". Medicine and science are extremely worthy endeavors, and have accomplished countless good for us all. And we both agree that the scientific facts are the starting point for these public policy decisions. But they must be the correct scientific facts. And, may I remind you, that they are also the starting point for the correct formation of conscience, and for the moral decision making process?3 Thus isn't it even more urgent for us to make certain that all of us in this room begin our deliberations with the most accurate and relevant science available? Remember that remarkably wise caution: "A small error in the beginning leads to a multitude of errors in the end."4 If we begin with erroneous science, then all of our decisions will be erroneous in the end -- and that could lead to great harm and injury!
Crippled Conscience: What is he talking about, Dr. Gyno?
Dr. Human Embryology: Quite right, Prof. Philos. Dr. "Science", you do fail to make several important distinctions. First, the question of when a human being begins to exist is strictly a scientific question, and should be professionally required to be answered by scientists -- but only by us scientists who are academically credentialed human embryologists.5 After all, we are the scientific experts who provide you scientists with the correct, accurate, and most current scientific facts concerning the beginning, growth and development of the early human embryo -- the subjects of this legislation on cloning and stem cell research that we are here to write. And our objective scientific facts are hardly "debatable", or based on subjective religious opinions.
In fact, human embryologist are professionally required to use those scientific facts which have been sanctioned by the international Nomina Embryologica Committee, along with the Carnegie Stages of Early Human Embological Development.6 This international committee consists of over 20 of the best and brightest human embryologists from around the world. They meet about every 3-5 years to examine and to evaluate the latest research studies in Human Embryology. They then determine which scientific facts about the beginning and early development of these human beings are accurate and reliable, and which are not (and thus rejected). Their scientific conclusions are also published in the international Nomina Anatomica.
Second, the question of when a human person begins to exist is not a scientific question at all, but rather left to philosophers and the like.
Third, there is no such thing as a "Pre-embryo". The term is a complete myth. There is, rather, an already existing, new living human embryo, a human being that begins to exist immediately at fertilization or cloning. Indeed, the terms "Pre-embryo" and "individualization" have been formally rejected by the Nomina Embryologica Committee as scientifically inaccurate and misleading. I just happen to have an example of their scientific rationale with me right here:
"The term 'pre-embryo' is not used here for the following reasons: (1) it is ill-defined because it is said to end with the appearance of the primitive streak or to include neurulation; (2) it is inaccurate because purely embryonic cells can already be distinguished after a few days, as can also the embryonic (not pre-embryonic!) disc; (3) it is unjustified because the accepted meaning of the word embryo includes all of the first 8 weeks; (4) it is equivocal because it may convey the erroneous idea that a new human organism is formed at only some considerable time after fertilization; and (5) it was introduced in 1986 'largely for public policy reasons' (Biggers)." ... Just as postnatal age begins at birth, prenatal age begins at fertilization." [O'Rahilly and Muller 2001, p. 88] ... "Undesirable terms in Human Embryology": "Pre-embryo"; ill-defined and inaccurate; use "embryo".7 [O'Rahilly and Muller 2001, p. 12]
Crippled Conscience: I don't think I want to hear any of this. Dr. Gyno, can't you do something?
Narrator: A fierce verbal scuffle immediately breaks out among several of the committee members, with Master Bioethics finally gaining unfettered speaking recognition. Well-Formed Conscience continues knocking politely on the other side of the heavy locked doors.
Master Bioethics (in a scornful tone): Mr. Chairman, please. This scientist is absurdly wrong! As everyone knows, the "Pre-embryo" has been the international scientific standard used for decades now in all sorts of private and public documents, guidelines, regulations, laws, etc. At fertilization or cloning there just simply is no embryo, no organism, no "developmentally single human being", no person, no pregnancy. The embryo doesn't begin until the formation of the inner cell mass in the blastocyst -- about 5-7 days after fertilization. Pregnancy doesn't begin until the implantation of the zygote -- or fertilized egg. And besides, almost two-thirds of the products of normal fertilization are lost as "wastage" before they even implant. How could they possibly be human beings already? Everybody here agrees on these "scientific" facts. Right, Judge?
Jaded Judge: Well, eh ......... . That's right. Until 14-days there is only a -- what did you call it -- a "possible human being", or a "potential human being" -- yes, a "Pre-embryo". At least that is how I was advised by my expert bioethicists. Those other people just couldn't make up their minds about it. Of course ............ if there is a human being present immediately at fertilization or cloning, then we would have to go back and review that legal decision, as we so stated.
Crippled Conscience: Please! Those little "Pre-embryo" things are just blobs of the mother's tissues, bunches of cells -- sort of like blood clots! Dr. Gyno assured us of these scientific facts. And he should know. He is part owner of a very famous IVF clinic, and does a lot of IVF research himself.8 With such expert scientific information I gladly signed my "informed consent" forms and donated my tissues to his distinguished research team just yesterday! I am so grateful for all the good to society my tissues can do to help advance science and to cure all such devastating diseases.
Dr. Human Embryology: With all due respect, Your Honor and Crippled Conscience, it has been known, and universally agreed for well over a hundred years now, that a new unique living human being begins to fully exist immediately at fertilization. Indeed, this has been known since 1880's, with the publication of Wilhelm His' three-volume treatise on Human Embryology.9 Every human embryologist knows this. But then, no one on your Court, Your Honor, accepted our professional expert position on this question. Only amicus briefs from bioethicists, mouse molecular biologists and frog embryologists were considered relevant.
However, let me take the opportunity now to set the record straight. Fertilization is indeed the beginning of: the embryo, the embryonic period, the human organism, the genetically and developmentally individual human being, and normal pregnancy. "Wastage" usually occurs because the embryo is abnormal, or the uterus is not properly prepared. If it is a normal embryo, it's unfortunate death does not negate it's real but short existence as a living human being. And there is no such thing as a "fertilized egg", especially one that would implant in the uterus. Nor is there such a thing as an "ovum". Further, the whole blastocyst is the embryo, not just the cells from the inner cell mass. I can prove these scientific facts with just these few direct quotations from several of our best and brightest human embryologists, some of whom have served on the Nomina Embryologica Committee for decades:10
"Embryonic life commences with fertilization, and hence the beginning of that process may be taken as the point de depart of stage 1. Despite the small size (ca. 0.1 mm) and weight (ca. 0.004 mg) of the organism at fertilization, the embryo is 'schon ein individual-spezifischer Mensch' (Blechschmidt, 1972). ... Fertilization is the procession of events that begins when a spermatozoon makes contact with an oocyte or its investments and ends with the intermingling of maternal and paternal chromosomes at metaphase of the first mitotic division of the zygote (Brackett et al., 1972). ... Fertilization, which takes place normally in the ampulla of the uterine tube, includes (a) contact of spermatozoa with the zona pellucida of an oocyte, penetration of one or more spermatozoa through the zona pellucida and the ooplasm, swelling of the spermatozoal head and extrusion of the second polar body, (b) the formation of the male and female pronuclei, and (c) the beginning of the first mitotic division, or cleavage, of the zygote. ... The three phases (a, b, and c) referred to above will be included here under stage 1, the characteristic feature of which is unicellularity. [See Stage 1 of the Carnegie Stages of Early Human Embryonic Development, at: http://nmhm.washingtondc.museum/collections/hdac/stage1.pdf] (emphases added)
"Although life is a continuous process, fertilization ... is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is formed ... [The] coalescence of homologous chromosomes results in a one-cell embryo. ... [I]t is now accepted that the word embryo, as currently used in Human Embryology, means 'an unborn human in the first 8 weeks' from fertilization". [O'Rahilly and Muller, 2001, p. 87]
"Human pregnancy begins with the fusion of an egg and a sperm, ... Finally, the fertilized egg, now properly called an embryo, must make its way into the uterus ....". [Carlson 1999, p. 2]
"In this text, we begin our description of the developing human with the formation and differentiation of the male and female sex cells or gametes, which will unite at fertilization to initiate the embryonic development of a new individual. ... Fertilization takes place in the oviduct [not the uterus]... Embryonic development is considered to begin at this point. ... This moment of [embryo] formation may be taken as the beginning or zero time point of embryonic development." [Larson 1997, pp. 1, 17]
Although fertilization may occur in other parts of the tube, it does not occur in the uterus." [Moore and Persaud 1998, pp. 2, 34]
"This process, which occurs about 4 days after fertilization, is called cavitation, and the fluid-filled space is known as the blastocoele. At this stage, the embryo as a whole is known as a blastocyst. (p. 38) ... At the blastocyst stage, the embryo consists of two types of cells: an outer superficial layer (the trophoblast) that surrounds a small inner group of cells called the inner cell mass. The appearance of these two cell types reflects major organizational changes that have occurred within the embryo and represents the specialization of the blastomeres into two distinct cell lineages. Cells of the inner cell mass give rise to the body of the embryo itself plus a number of extraembryonic structures." (Carlson 1999, pp. 39-40)
"'Primordium'" [e.g., "embryo proper"]: This term refers to the beginning or first discernible [i.e., using a microscope] indication for the earliest stage of development of an organ or structure." (Moore and Persaud 1998, p. 3)
"Thus the germ layers should not be considered in rigid isolation one from another, and many interdependences, particularly what are termed epithelio-mesenchymal interactions, are important in development. (p. 10); ... The developmental adnexa, commonly but inaccurately referred to as the "fetal membranes", include the trophoblast, amnion, chorion, umbilical vesicle (yolk sac), allantoic diverticulum, placenta and umbilical cord. These temporary structures are interposed between the embryo/fetus and the maternal tissues. ... The adnexa are programmed to mature fast, to age more rapidly, and to die sooner than the embryonic/fetal body. Nevertheless they are genetically a part of the individual and are composed of the same germ layers." (O'Rahilly and Muller 1994, p. 51).
"The appearance of the blastocyst demonstrates the differentiation into (1) trophoblast (or trophectoderm), the peripherally situated cells and (under the influence of E-cadherin) in first epithelium formed, and (2) embryonic cells proper. The latter, at first few in number, form the inner cell mass (ICM). The trophoblast at the future site of attachment is sometimes termed polar, the remainder being called mural. The cells of the ICM (inner cell mass) are considered to be totipotent initially." (O'Rahilly and Muller 2001, p. 39)
"A high percentage of abortuses (30-80%, depending on the study) are structurally abnormal, and it is maintained that all abortuses under 4 postovulatory weeks have abnormally formed embryonic tissue. Thus, spontaneous abortion greatly reduces the number of malformed fetuses born." [O'Rahilly and Muller 2001, pp. 92-93]
"Early spontaneous abortions occur for a variety of reasons, one being the presence of chromosomal abnormalities in the [embryo]. The early loss of embryos, once called pregnancy wastage, appears to represent a disposal of abnormal conceptuses that could not have developed normally, i.e., there is a natural screening of embryos." [Moore and Persaud 1998, p.p. 42 - 43]
"Egg"; best confined to the hen and to cuisine; use "oocyte". "Ovum"; does not exist in human; use "oocyte", "ootid", "embryo". [O'Rahilly and Muller 2001, p. 12]
Narrator: At this point everyone in the dark meeting room starts shouting all at once; Well-Formed Conscience begins banging fiercely on the outside of the heavy locked doors. Eventually the Chairman regains control.
Mr. Chairman: Order! Let's have order in this meeting! Dr. Human Embryology, perhaps you can explain to us in a bit more detail exactly what happens before, during and immediately after fertilization that can help to further illuminate your disagreement with Dr. "Science"?
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