Testimony to DHHS Re Rescinding Provider Conscience Clause

Dianne N. Irving
copyright April 6, 2009
Reproduced with Permission

To: The Department of Health and Human Services (also posted online at http://www.Regulations.gov; comment ID 80945f22)

From: Dianne N. Irving, M.A., Ph.D., scientist and medical ethicist
5108 Randall Lane, Bethesda, MD 20816, 301-229-4176

Date: April 6, 2009

Re: The Existing Provider Conscience Clause (document 0991-AB49)

Pharmacists, hospitals, doctors and nurses should definitely not have to do abortions against their conscience. To force them by law or regulation to do so would force them to kill innocent living human beings. Such a law or regulation would be de facto a grossly unjust law that should not be tolerated by any civilized society.

Those who would force others to kill innocent human beings at the request of others often attempt to appeal to false scientific claims, e.g., the product of fertilization is simply a blob, a bunch of cells, or a piece of the mother's tissues, a potential or possible human being, a "pre-embryo", etc. However, such claims are absurd, have no basis in scientific fact and surely no viable or just law should be based upon them. It has been known for well over 125 years (with the voluminous work of Wilhelm His (Anatomie menschlicher Embryonen, 1880-1885) that a new, living, individual, genetically unique human being (a single-cell human organism) is formed at the beginning of the process of fertilization. This and similar famous research was used as the basis of the secular Carnegie Stages of Early Human Embryonic Development, instituted in 1942, and documented and updated since then by the international nomenclature committee on human embryology, i.e., the Nomina Embryologica which was part of the larger Nomina Anatomica (now called the Terminologia Embryologica and Terminologia Anatomica). The Carnegie Stages of Early Human Embryonic Development cover the new developing human being through the first 8 weeks of life, comprising 23 Stages, and are accessible online at: http://nmhm.washingtondc.museum/collections/hdac/Select_Stage_and_Lab_Manual.htm at the National Museum of Health and Medicine. Quoting directly from the Carnegie Stages:

Fertilization, which normally takes place in the uterine (fallopian) tube, is the procession of events that begins when a spermatozoon mature sperm makes contact with an oocyte and ends with the intermingling of maternal- and paternal-derived chromosomes at metaphase of the first mitotic (cell) division of the zygote. Stage One of the embryo thus includes (emphasis in the original): (a) the penetrated oocyte - the term used once a haploid spermatozoon has penetrated the diploid oocyte (causing the diploid oocyte to half its number of chromosomes to 23) and, strictly, "after the individual plasma membranes of the sperm and of the oocyte have become one"; (b) the ootid, characterized by the presence of the male and female haploid pronuclei (each pronuclei containing 23 chromosomes); and (c) the zygote, which characterizes the last phase of fertilization. (emphases added; http://nmhm.washingtondc.museum/collections/hdac/stage1.pdf)

Every professional human embryology textbook not only agrees with the Carnegie Stages, but are professionally required to use the Carnegie superscripts in their texts. Examples of the accurate scientific facts of human embryology from such textbooks include the following:

Keith Moore and T. V. N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed. only) (Philadelphia: W. B. Saunders Company, 1998): "Human development is a continuous process that begins when an oocyte (ovum) from a female is fertilized by a sperm (or spermatozoon) from a male. (p. 2); ibid.: ... but the embryo begins to develop as soon as the oocyte is fertilized. (p. 2); ibid.: ... this cell results from the union of an oocyte and a sperm ... is the beginning of a new human being (i.e., an embryo). (p. 2); ibid.: Human development begins at fertilization, the process during which a male gamete or sperm ... unites with a female gamete or oocyte ... This highly specialized, totipotent cell marks the beginning of each of us as a unique individual." (p. 18).

William Larsen, Human Embryology (New York: Churchill Livingstone, 1997): "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. ... (p. 1)

Ronan O'Rahilly and Fabiola Muller, Human Embryology & Teratology (New York: Wiley-Liss, 1994): "Fertilization is an important landmark because, under ordinary circumstances, a new, genetically distinct human organism is thereby formed. (p. 5); ibid.: Fertilization is the procession of events that begins when a spermatozoon makes contact with a secondary oocyte or its investments ... (p. 19); "The ill-defined and inaccurate term pre-embryo, which includes the embryonic disc, is said either to end with the appearance of the primitive streak or ... to include neurulation. The term is not used in this book." (p. 55).

O'Rahilly and Muller 2001: 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." (p. 88) (emphases added) (Note: O'Rahilly is one of the originators of The Carnegie Stages of Early Human Embryological Development, and has sat on the international Nomina Embryologica Committee for decades -- DNI)].

Bruce Carlson, Human Embryology and Developmental Biology (St. Louis, MO: Mosby, 1994): "Human pregnancy begins with the fusion of an egg and a sperm." (p. 3); " ... finally, the fertilized egg, now properly called an embryo, must make its way into the uterus ...." (p. 3).

Carlson (1994), p. 407: "After the eighth week of pregnancy the period of organogenesis (embryonic period) is largely completed and the fetal period begins." O'Rahilly and Muller (1994), p. 55: "The embryonic period proper ... occupies the first 8 postovulatory weeks ... The fetal period extends from 8 weeks to birth ... ."; Moore and Persaud (1998), p. 6: "The embryonic period extends to the end of the eighth week ... After the embryonic period, the developing human is called a fetus. During the fetal period (ninth week to birth) ... ."

It is also an objective scientific fact that the use of many "contraceptives" can be abortifacient, including the "morning-after pill", or "emergency contraception", as stated by Moore (a member of the INEC):

(Keith Moore and T.V.N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed. -- use this edition only)(Philadelphia: W.B. Saunders Company, 1998), pp. 45, 58, 59, 532):

-- "Inhibition of Implantation: The administration of relatively large doses of estrogens ("morning-after pills") for several days, beginning shortly after unprotected sexual intercourse, usually does not prevent fertilization but often prevents implantation of the blastocyst. Diethylstilbestrol, given daily in high dosage for 5 to 6 days, may also accelerate passage of the dividing zygote along the uterine tube (Kalant et al., 1990. Normally, the endometrium progresses to the secretory phase of the menstrual cycle as the zygote forms, undergoes cleavage, and enters the uterus. The large amount of estrogen disturbs the normal balance between estrogen and progesterone that is necessary for preparation of the endometrium for implantation of the blastocyst. Postconception administration of hormones to prevent implantation of the blastocyst is sometimes used in cases of sexual assault or leakage of a condom, but this treatment is contraindicated for routine contraceptive use. The "abortion pill" RU486 also destroys the conceptus by interrupting implantation because of interference with the hormonal environment of the implanting embryo.

"An intrauterine device (IUD) inserted into the uterus through the vagina and cervix usually interferes with implantation by causing a local inflammatory reaction. Some IUDs contain progesterone that is slowly released and interferes with the development of the endometrium so that implantation does not usually occur." (p. 58)

-- [Question Chapter 2, #5 for students:]

"#5. A young woman who feared that she might be pregnant asked you about the so-called "morning after pills" (postcoital birth control pills). What would you tell her? Would termination of such an early pregnancy be considered an abortion?" (p. 45)

[Answer #5 for students:]

"Chapter 2

#5. Postcoital birth control pills ("morning after pills") may be prescribed in an emergency (e.g., following sexual abuse). Ovarian hormones (estrogen) taken in large doses within 72 hours after sexual intercourse usually prevent implantation of the blastocyst, probably by altering tubal motility, interfering with corpus luteum function, or causing abnormal changes in the endometrium. These hormones prevent implantation, not fertilization. Consequently, they should not be called contraceptive pills. Conception occurs but the blastocyst does not implant. It would be more appropriate to call them "contraimplantation pills". Because the term "abortion" refers to a premature stoppage of a pregnancy, the term "abortion" could be applied to such an early termination of pregnancy." (p. 532) (emphases added)

-- [Question chapter 3, #2 for students]:

"Case 3-2

A woman who was sexually assaulted during her fertile period was given large doses of estrogen twice daily for five days to interrupt a possible pregnancy.

[Answer Chapter 3, #2 for students:]:

"Chapter 3-2 (p. 532)

Diethylstilbestrol (DES) appears to affect the endometrium by rendering it unprepared for implantation, a process that is regulated by a delicate balance between estrogen and progesterone. The large doses of estrogen upset this balance. Progesterone makes the endometrium grow thick and succulent so that the blastocyst may become embedded and nourished adequately. DES pills are referred to as "morning after pills" by lay people. When the media refer to the "abortion pill", they are usually referring to RU-486. This drug, developed in France, interferes with implantation of the blastocyst by blocking the production of progesterone by the corpus luteum. A pregnancy can be detected at the end of the second week after fertilization using highly sensitive pregnancy tests. Most tests depend of the presence of an early pregnancy factor (EPF) in the maternal serum. Early pregnancy can also be detected by ultrasonography."

These are not "religious" or subject personal "opinions", but rather are the internationally acknowledged objective scientific facts that have been well documented and well known for a very long time. This is why pharmacists, hospitals, doctors and nurses should not have to do abortions against their conscience, as they have the right to refuse to be legally forced to kill any living innocent human beings. This is why the existing Provider Conscience Clause should not be rescinded.