[Paleopsych] J. Med. Ethics: In the world of Dolly, when does a human embryo acquire respect?

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In the world of Dolly, when does a human embryo acquire respect?
J Med Ethics 2005;31:215-220

C Cameron and R Williamson

Murdoch Children's Research Institute, University of Melbourne
Department of Paediatrics, Royal Children's Hospital, Melbourne,
Australia

Correspondence to:
Professor R Williamson
The Dean's Ganglion, Faculty of Medicine, University of Melbourne,
Melbourne 3070, Australia; r.williamson at unimelb.edu.au
<mailto:r.williamson at unimelb.edu.au>

Original version received 4 September 2003

Revised version received 16 October 2003

Accepted for publication 2 November 2003


ABSTRACT
For most of the 20th century, it was possible to regard fertilisation as
the identifiable point when life begins, because this moment could be
defined unequivocally and was thought to be the single most essential
biological step in the establishment of a new human entity. Since the
successful reproductive cloning of Dolly and other mammals, it is clear
that any human cell has the potential to supply the full genome of an
embryo, and hence a person, without going through fertilisation. At what
point in time do such embryos acquire the respect accorded to human
beings? The authors argue that the time of implantation is the most
useful point at which the potential and the intention to create a new
person are translated into reality, because from that point a new life
develops. Implantation differentiates a somatic cell in culture (which
is not due respect) from a human entity that has acquired its own
identity and developmental potential. The authors examine the value of
quickening or viability as alternative developmental stages in the
process of acquiring respect for the Dolly embryo.

   _____

Keywords: cloning; fetus; abortion; viability; Dolly the sheep

Before 1827, when Von Baer discovered and described the female ovum and
scientists began to understand fertilisation,
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> little was
known about the biological steps that occurred to create the human
embryo. Aristotle, whose teachings formed much of our traditional
philosophical understanding of the origin of the human individual,
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> believed that
a male's sperm reacted with the woman's blood in her womb causing it to
develop into a living being. If the sperm (seed) remained in the womb
for seven days from intercourse, conception would take place following
the setting of the menstrual blood mixed with the semen, to form a
single living being.

Aristotle pressed the comparison of the embryo to a seed sown in the
ground whose parts are undifferentiated and in a state of potency until
the first principle of growth becomes distinct when a shoot is put
forward to provide nourishment.
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> In the early
embryo Aristotle found no evidence of any activity other than
nourishment. He believed a nutritive or vegetative soul was acquired to
enable nourishment and growth to take place. At around the 40th day,
this nutritive soul was replaced by a "sensitive" soul when the organs
required for sensation begin to develop, enabling the fetus to begin to
enjoy animal life. Subsequently the "rational" soul appears, at a time
not specified by Aristotle, from an undefined outside place, which
completes the human form. Aristotle saw the "soul in man as the form of
the body, the life-principle that enables matter to become a man in
actuality." <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1>

Aristotle's view remained unchallenged for about two thousand years.
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> Where there
were differences, as with Thomas Aquinas, these were relatively minor.
The fundamental theory was Aristotelian. The details of the theological
debate on the timing of ensoulment are dealt with in Norman Ford's book
When did I begin? Conception of the human individual in history,
philosophy and science,
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> and in the
2002 Annual Report of the President of the Royal Society, Lord May.
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R2>

After the discovery of the mechanism underlying embryogenesis in 1827,
philosophers questioned Aristotle's theory of delayed rational
animation. By the end of the 19th century, most Christian philosophers
agreed that ensoulment (the religious counterpoint to the acquisition of
respect as an individual) occurred at the time of fertilisation. Many
contemporary philosophers still wish to uphold the tradition of
immediate rational ensoulment from the time of conception.
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> It has the
great advantage of being simultaneously definitive and simple.
Unfortunately, it no longer can be regarded as scientifically correct.

RELIGION

The Bible, the Koran, and the Talmud do not actually say when life
begins, although each has been the subject of various interpretations.
Within each religion, there is a wide range of views varying from
radical to conservative. The advent of IVF posed a challenge to views
that relied on definite intervals between fertilisation, implantation,
quickening, and birth, as conception could occur outside the womb and
implantation could be delayed for months or years. This uncertainty
actually caused a firm reinforcement of the view among many religious
philosophers that fertilisation is the critical step in creating a new
human individual.

Let us begin by looking briefly at the views of a number of different
religions, and a scientific (non-religious) and a modern philosophical
view.

Catholicism

The traditional Catholic position is that life begins when the spiritual
soul is infused into the human subject, which is at fertilisation. From
that moment "every human life at every stage is equally worthy of
protection" <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R3>
and its rights as a person should be recognised, including its right to
life. In regard to embryos created by fertilisation in vitro, they are
also "to be considered human creatures and subjects with rights: their
dignity and right to life must be respected from the first moment of
their existence". 1,
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1>
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R4>

Within the Catholic Church there are differing views on when life
begins. "Many eminent Catholic moralists, both in previous centuries and
today, particularly those relying on Aristotelian categories, have
subscribed to theories of "delayed" or "mediate" animation-that is, that
the soul is infused into the human subject at points later than
fertilisation, with the corollary that individual human life and
personhood do not begin until a later stage in the development of the
human embryo." <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R5>
This less traditional view of delayed animation may enable recognition
and respect for an embryo created other than by fertilisation. However
it is difficult to envisage how traditional Catholics would view such an
embryo/baby.

Islamism

Many Muslim scholars believe that ensoulment of the fetus does not occur
until the fourth month of pregnancy (after 120 days), which is around
the time quickening occurs. Such belief is based on passages from the
Koran as well as narrations from the prophet Mohammed. The Prophet
states "Each of you possesses his own formation within his mother's
womb, first as a drop of matter for forty days, then as a blood clot for
forty days, then as a blob for forty days, and then the angel is sent to
breathe life into him."
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R6>

However other Muslims interpret the Koran differently, and believe the
"hanging embryo stage" starts about six days after fertilisation when
the embryo attaches to the inner lining of the uterus. A human being is
created from this tiny hanging embryo, and such individuals are entitled
to protection. <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R7>


Buddhism Buddha provided that three conditions are required to be present 
for human life to begin: (1) intercourse must take place; (2) it must take 
place in "due season", that is, at the appropriate time in the menstrual 
cycle, and (3) the spirit of the being seeking rebirth must be at hand. If 
all three conditions are present the descent of the intermediate being may 
occur and a person will be created. Such events usually occur at the 
latest at the time of syngamy. 
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R8> Based on this 
traditional view, Buddhists do not "object to the technique of IVF in 
itself, since it merely assists nature in achieving its normal ends." 
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R8> After a minor 
detour nature is once again back on course, and the chain of normal 
development will resume. However they do not approve of the methods used 
in IVF. <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R8> From 
these views, it is hard to speculate on what the attitude of Buddhists 
would be to an embryo created other than by fertilisation.

Judaism

"Jewish law does not regard a fertilised egg as a person before it is
implanted in the womb"
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R9> and processes
invisible to the human eye are not forbidden by Jewish law. Until the
embryo is implanted the fertilised egg does not have the ethical status
of a person. <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R9>
Many Jewish leaders make a fundamental distinction between the embryo in
the earlier and later periods of pregnancy. Thus an embryo created other
than by fertilisation would probably be recognised under Jewish law. As
in Aristotelian philosophy, 40 days is postulated as a significant time
in the development of the embryo. 10
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R10> It is
interesting to note that this is the time of closure of the neural tube,
a time that has been interpreted as the beginning of a capacity for
sentience in the embryo.

Scientific view

Most scientists do not believe that a new human life can be defined as
beginning at any particular moment, but see it as evolving gradually
during embryonic development. This is particularly true if the Darwinist
view of evolution is taken into account, because human development in
utero encapsulates the processes of development for many other species.

Many scientists see the appearance of the primitive streak in the embryo
at 14 days as an important stage in development. "Before fourteen days
the embryo, or pre-embryo as it was scientifically known, was a loose
cluster of first two, then four, then sixteen cells, undifferentiated.
An undifferentiated cell could develop into any of the types of cell
that go to make up the human body, and some of them would not become
part of the embryo at all, but would form the placenta." 11
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R11> After 14
days, the primitive streak appears, twinning is no longer a possibility,
and the cells develop into particular lineages.

>From this stage it is no longer legally possible to carry out research
on human embryos, either in the UK or Australia. 12
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R12> Because the
appearance of the primitive streak corresponds to the beginning of
neural (brain) function, many scientists will not carry out experiments
on embryos older than 14 days. Although scientists regard development as
a continuum, many argue that there is an increment of respect due to a
human embryo at 14 days, and progressively after that time.

Philosophical view

One school of modern philosophy does not give the embryo moral status or
respect as a person until the embryo, fetus, or child reaches a stage in
its development at which it attains some recognisable intellectual
ability, capacity, or brain function. "The question must be, what should
lead us to accept the embryo or the foetus or the neonate or the child
or anything at all as having that range of qualities that makes them
persons." 13 <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R13>
The answer given by Harris is "... a person will be any being capable of
valuing its own existence." 13
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R13> Michael
Tooley believes "An organism possesses a serious right to life only if
it possesses the concept of a self as a continuing subject of
experiences and other mental states, and believes that it is itself such
a continuing entity." 14
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R14> Savulescu
does not think we begin to exist as people or "morally relevant
entities" until our brain begins to function (consciousness begins)
which is at least at 20 weeks of fetal gestation. 15
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R15>

Commentary

Since discovering the scientific beginnings of human life, that embryos
are created by fertilisation of an egg by a sperm, the Catholic Church
has had a great interest in and written extensively about when human
life begins, or at least when it deserves respect, particularly in the
context of IVF embryos. It is perhaps ironic that of all the Churches,
only the Catholics attempted, towards the end of the 19th century, to
accommodate the new science of embryology in its doctrine, and because
of this they now find themselves expressing conservative views. Other
religions that have not stated their religious views as dogma have left
themselves more flexibility in dealing with mammalian cloning, and an
embryo created other than by fertilisation will be more readily accepted
by members of such religions.

Some of the more liberal Catholic theologians, such as Dr Norman Ford,
have adopted a more contemporary view on when life begins based on
science, philosophy, history, and theology. Dr Ford, focusing more on
the scientific development of the embryo, believes a human individual is
not formed until the appearance of the primitive streak, around 14 days;
although he advocates that human life should be respected from
conception due to its potential-regardless of whether a human individual
or person has already been formed. 16
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R16> However, it
is difficult to place this in the context of a doctrine that equates the
time of fertilisation with the time of acquisition of personhood.

The view outlined above from some philosophers also poses problems by
disregarding the issue of potential. The problems that arise in overuse
of potential are clear from study of the Catholic position. On the other
hand, ignoring potential implies that only a fully sentient human being
is deserving of rights and respect, and this does not accord with legal
or ethical constructs in most societies, even from those without
religious views.

WHAT HAS DOLLY CHANGED?

Dolly the cloned sheep was created by fusing the 
nucleus of a mammary gland cell from an adult sheep with another sheep's 
enucleated egg. Dolly was born on 5 July 1996. In theory, the same process 
can create a human embryo. As of 2003, there are no data that a human 
being has been successfully created by this method, but most scientists 
agree it is possible in principle.

Cloning a mammalian embryo from a somatic cell (any cell of the body,
other than a reproductive cell) ("Dolly cloning") does not use the
genomes (genetic material) of either a sperm or an egg. At present, an
enucleated egg cell is often used as a nurturing environment for the
somatic cell nucleus that provides the genetic material for the new
embryo, but the egg cell is a facilitative incubator and does not
provide meaningful genetic input to the new individual. It is already
possible to use a frog egg to nurture and activate the nucleus from an
adult human cell and switch on genes that are characteristic of human
embryonic stem cells. 17
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R17> It is likely
that it will only be a few years, if that, before scientists create a
human embryo from the nucleus of a somatic cell without any egg or sperm
components at all. It has recently been shown that fusion of an adult
cell with an embryonic stem cell also gives a potential embryo with a
genome from the adult. This raises the question: for a "Dolly clone",
because there is no fertilisation, when does "life begin"? When does the
embryo/fetus/baby acquire respect?

So what has changed?

*	Fertilisation is no longer required to create an embryo;

*	A sperm is no longer required to create an embryo;

*	An egg may not be required to create an embryo;

*	One or more embryos may be created that have the same DNA as
another living individual;

*	As with IVF:

1.	it is possible to create an embryo in a petri dish; and

2.	the embryo in a petri dish may be:

3.	implanted in the womb;

4.	frozen;

5.	used for scientific experimentation;

6.	discarded; or

7.	used in any other manner, whether or not legally and/or morally
acceptable, such as for therapy, or for human cloning (which is illegal
in the UK and Australia).

At present scientists are only able to allow an embryo to develop in a
Petri dish for approximately 14 days. Unless successfully implanted in
the womb, the embryo will not develop and will die. However, let us
consider the implications if, in the future, an embryo created other
than by fertilisation can be developed and grown outside the womb past
this stage. It is even possible to consider an artificial uterine
environment that can sustain an embryo until the stage of "viability"
(until it can survive independently). For such a human life, many
important ethical issues will arise, including the issue of respect.
Although many of the issues we discuss will apply in this context, we do
not specifically address the issue of respect for such a life. We are
discussing the events that are with us at present or likely to arise in
the near future.

Embryos can be used for purposes other than reproduction. Since the
passing of Australian Commonwealth legislation in 2002, it is legally
permissible to use embryos (created before 5 April 2002) which are
surplus to needs for IVF, for approved research. 18
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R18>

Before addressing the question of when an embryo created other than by
fertilisation acquires respect, we will look at whether or not such an
embryo falls within the definition of "an embryo".

What is an "embryo"?
An embryo is traditionally thought of as an unborn animal or human in
the early stages of development which was created by fertilisation. It
is now possible to create an embryo other than by fertilisation. Does
such an embryo still fall within the definition of "an embryo" because
it has been created differently? Traditional Catholics have difficulty
viewing such "embryos" as human embryos as they are not formed by
fertilisation, which since 1870 has been the definition of the timing of
ensoulment. Indeed, until Dolly-cloning, most people would have assumed
that every human embryo (including IVF embryos) would be created by
fertilisation, as until that time a human being could not be created in
any other way.

An "embryo" is defined in the dictionary as "an animal in the early
stages of growth before hatching; a developing unborn human during the
first eight weeks after conception ... something as yet undeveloped". 19
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R19> This
definition implies that an embryo is created by fertilisation, by
reference to "eight weeks after conception". The New Oxford Dictionary
of English includes in its definition of an embryo "an unborn human
offspring especially in the first eight weeks from conception, after
implantation but before all the organs are developed." 20
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R20> This
definition also envisages the embryo as having been conceived and
defines it as being "after implantation". If an embryo is defined as
only being the product of fertilisation of an egg by a sperm, then the
product of Dolly-cloning is not an embryo even though it might give rise
to a fetus, a child, and an adult in time. This is clearly nonsense.

A more modern definition is provided by Norman Ford who defines a human
embryo as "a totipotent single-cell, group of contiguous cells, or a
multicellular organism which has the inherent actual potential to
continue species specific ie typical, human development, given a
suitable environment". 16
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R16> An embryo
created other than by fertilisation may develop into a human being given
the right environment and would have all the characteristics of an
embryo created by fertilisation. Such an embryo falls within Norman
Ford's definition, which we adopt in this paper.

A European Committee looking into the legality of human cloning was of
the view "if illicitly a human clone were fathered [sic], he or she
would be fully human and none of the arguments ... presented could be
used to challenge his or her human dignity". 21
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R21> We suggest
that should an embryo be created other than by fertilisation and be
implanted in a womb with the potential to develop to a fetus and a
child, it is an embryo, the only difference being the manner in which it
was created.


A. WHEN DOES AN EMBRYO CREATED OTHER THAN BY FERTILISATION BEGIN TO
ACQUIRE RESPECT/PERSONHOOD?
Respect
"Respect" has both an objective and a subjective component, the
relevance or importance of which may vary depending on how and in what
context it is used. In medicine, living human beings are accorded a
significant level of respect that is not accorded to dead human beings,
but even this is tempered in terms of value judgments on quality of
life. In biology, greater respect is accorded to individuals who
reproduce at a higher rate and contribute disproportionately to the
survival and fitness of the species. In law, respect is treated as if
objective, depending upon the circumstances in each particular case and
what is reasonable and acceptable; not as much importance is given to
variation between individuals. Modern philosophers see people earning
respect only when they matter morally. For a family member, respect may
be subjective and accorded irrespective of personal values, on the basis
of a relationship alone. While recognising these ambiguities, we are
subsuming all of these views into a single word, "respect", in this
analysis.

Respect may be accorded to embryos on each or all of a variety of
criteria, depending on their philosophical or religious views and their
relationship to the embryo, including:

1. the development status of the embryo;

2. the embryo's potential;

3. the value of the embryo to other people or to themselves.

When does a Dolly embryo acquire respect?
Over the centuries a number of different positions have emerged as to
when an embryo deserves respect as a human being. Since 1870,
traditional Catholics have held the view that it acquires full respect
at fertilisation. However, for embryos created by nuclear transfer in a
laboratory, fertilisation does not occur and is not relevant. The Dolly
embryo is no different genetically when in the laboratory from the
somatic cell from which it is derived. It only acquires ethical value
when both the intention and the capability for development into a person
are simultaneously realised.

The most important stage in the development of an embryo created outside
the womb, such as a Dolly embryo, is implantation, as without successful
implantation the embryo cannot develop into a human being. Its potential
to develop is theoretical until it is implanted; on implantation, it
becomes real. Upon the successful act of implantation the embryo will
begin to acquire respect, because after implantation development takes
place (at least in principle) which, if uninterrupted, leads to the
birth of a human being. The embryo is also at the stage when the
primitive streak appears, the cells begin to differentiate, there is no
longer any chance of twinning, and the embryo thereafter develops into a
recognisable fetus. As Ford says, this may be regarded as a biological
correlate of the definitive stage of individuality.
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1>

Until implantation with the Dolly embryo, there is no clarity as to what
the future will be of the cells in culture that could become an embryo.
After implantation, there are no reasons why any embryo, whatever its
origin, should be treated any differently from an embryo at the same
stage created by fertilisation. It may be that the Dolly embryo is at
high risk of spontaneous abortion, or of birth handicap, but in
principle any embryo faces these risks at some level or other.

Does an embryo in culture deserve any respect if its future is unknown?
This is a difficult question. On the one hand, embryos created by IVF of
an egg by a sperm and allowed to develop to the eight cell stage before
implantation, with the intention to create a pregnancy, have always been
treated with respect by doctors and scientists. This respect extends to
IVF embryos that are used for experimentation. This latter case is
comparable to the respect accorded to human cadavers by medical students
in anatomy lessons. 22
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R22> Most people
would not accord this respect to sperm or egg cells before
fertilisation. Somatic cells in culture are now comparable to IVF
embryos in that they can also give rise to embryos if treated in a
particular way and then implanted in a womb. However, somatic cells are
constantly dividing, generating new cells, and dying, and it would be
both unscientific and counterintuitive to accord respect to such cells.

We conclude that IVF embryos are entitled to some respect, if only
modest, "because they are alive and because they are regarded by others
as morally valuable", 22
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R22> for example,
by gamete donors. However, cells in culture from an individual are not
due this respect even if they are being prepared for use with the
intention of implantation so as to create an individual (something that
is illegal in Australia and in many other countries).

It is logical to regard implantation as marking the beginning of life
for embryos created other than by fertilisation. Indeed, "some
biologists suggest that we should regard implantation itself as
conception." <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1>
For embryos created other than by fertilisation, such a suggestion makes
sense.


B. ACQUISITION OF RESPECT AFTER IMPLANTATION
As discussed above, after implantation there is little difference
between the development in the womb of an embryo created by
fertilisation and a Dolly embryo. The only difference may be the higher
risk of abortion or birth handicap for the Dolly embryo. For embryos
created by fertilisation, implantation is also a very important stage in
their development as without successful implantation they will not
develop further. Implantation is followed by numerous important stages,
including development of the primitive streak (immediately after
implantation at around 14 days), fetal movement in the womb (quickening,
at approximately 15-20 weeks), brain life and the capacity for
sentience, viability, birth, and self awareness (post birth). 23
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R23>

Different religious and professional groups each have views as to which
is the most important stage. Viability is the criterion favoured by many
neonatologists and gynaecologists, particularly as a criterion for the
time when abortion is no longer acceptable, 23
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R23> but even this
view is not universal.

We believe that it is no longer possible to identify a single time (such
as fertilisation) at which an embryo acquires respect as a future
person. In view of the new technologies, the process of development of
the individual can be regarded as beginning at implantation. This would
clearly state that cells in culture that are not used for implantation
and have not been manipulated to form an embryo, do not deserve respect.
This is important as it is clear that every cell in any adult can (in
principle) give rise to an embryo if treated in a particular way and
implanted. It has the additional advantage of distinguishing clearly
between cells in culture in laboratories (which have the theoretical
potential to become people but no opportunity to do so), and cells
implanted in a womb that have acquired the potential to develop into an
infant without further intervention.

After implantation, when the process of acquiring respect begins, the
embryo acquires more respect as the pregnancy progresses, with
quickening being an important stage. Respect continues to increase until
viability. From the time of viability (currently approximately 26 weeks
in most first world countries) the embryo should be entitled to full
respect as a human being.

Quickening
"Quickening" is the time when the pregnant woman can feel the fetus move
inside her womb. This usually takes place 15-20 weeks in the first
pregnancy and earlier in subsequent pregnancies.

Not all pregnancies that follow implantation proceed to a successful
outcome; as many as one in three abort spontaneously. Perhaps for this
reason, it appears that the mother's respect for the embryo/fetus
gradually increases over time, as she becomes more aware of the
developing fetus and more confident that it will proceed to term and
become a baby. Quickening occurs shortly after the end of the first
trimester, at which time the risk of spontaneous abortion decreases
significantly. The mother's increase in respect can be equated with the
increase in value she gives to the life of the fetus. "For the question
about moral significance, the question that is, when do embryos morally
matter, is quite obviously one that must be answered by judgment and
decision, according to a particular moral standpoint. It is not a
question of fact but a question of value. How much should we value human
life in its early stages?" 24
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R24> The value a
mother places on the growing fetus increases as the pregnancy proceeds
and the fetus develops.

Modern ultrasound equipment and advances in modern science also enable
doctors and thus parents to know a lot more about the developing fetus.
"It is now possible to detect many lethal fetal abnormalities with
certainty by about 16 weeks gestation".
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R1> A woman's
anxiety about the risk of having an abnormal fetus is reduced by
prenatal screening. If the screening gives a normal result, this
provides reassurance of a probable healthy outcome to the pregnancy.

The significance of quickening is implicit in the views of the Muslim
and Jewish religions. Historically, in England, "before the introduction
of Lord Ellenborough's Act (1803) it was not a crime under English
common law to carry out an abortion before quickening, which was
described as "... the time when 'the infant is able to stir in the
mother's womb', and which was generally around the fourteenth week of
pregnancy". 25
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R25>

Many doctors are reluctant to perform an abortion after first trimester,
signalling an increase in respect for the developing fetus. In England,
Scotland, and Wales abortion is permitted by law when two doctors decide
"that the pregnancy has not exceeded its 24th week and that the
continuance of the pregnancy would involve risk ..." 26
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R26> Despite this
freedom, almost 90% of abortions are performed before 13 weeks and fewer
than 2% take place after 19 weeks. 27
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R27> "A growing
number of doctors who are comfortable with early abortion decline to
provide, or even refer, for later procedures. Many NHS hospitals have
established arbitrary time limits of 12 or 14 weeks ..." 28
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R28> beyond which
they are unable or unwilling to carry out terminations of pregnancy.

Although quickening is an important stage in the development of the
fetus, with a significant increase in respect for the fetus both from
the mother/parents and doctors, it is variable in timing between
individuals. The fact that no easily defined scientific event takes
place makes it difficult to give it a high degree of importance as a
benchmark for the acquisition of respect.

Viability
Viability is "the stage of fetal development at which the fetus can
survive independently of the pregnant woman, given suitable intensive
care". 23 <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R23> It
is currently as early as 22 weeks in well equipped centres, depending
upon the birth weight and developmental stage of the fetus. It should be
noted that although a fetus can survive after intensive care from this
age, the outcomes are not always good, and many neonatal units are
reluctant to embark on resuscitation until 26 or 27 weeks of pregnancy.
Although the fetus can survive outside the uterus, no longer dependent
on its mother, its survival is totally dependent on technology. This is
also the time when consciousness (in terms of responsiveness to
environmental stimuli) begins. 15
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R15>

"Viability is the criterion favoured by many who work in the field of
neonatology, and also by some gynaecologists who accept abortion but who
also believe that at some stage in their development fetuses acquire a
right to life after which they should not be aborted." 23
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R23> John Wyatt, a
neonatologist, believes the UK law that allows late abortions, "is
morally and practically unsustainable". 29
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R29> He also notes
that some parents are horrified when the option of late term abortion is
explored.

As gestation progresses past the earliest stage of viability, the unborn
fetus is increasingly respected. As it moves from dependent to
independent and acquires the ability to survive outside the uterus, it
must be regarded, legally and ethically, as a legal person entitled to
the full set of rights of any other individual. 23
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R23> If it is
viable, it is arguable that it should have the same respect as a
neonate. Some newborn full term babies are fully dependent on
technology, requiring high maintenance and special care to survive. We
do not believe that a fetus generated by cloning technology should be
regarded differently to a fetus conceived by the union of an egg and
sperm.

In Australia, the law only recognises a baby having rights as a person
at birth. A child in the womb is only recognised as a person when it is
"completely delivered from the body of its mother and has a separate and
independent existence ... and is living by virtue of the functioning of
its own organs". 30
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R30> This would
include a baby dependent on technology. It is difficult for an embryo or
fetus to have any rights while it is in the womb. If it is born with a
disability or deformity that is caused by an accident while in the womb,
it may have a cause of action in negligence against the wrongdoer once
it is born. 31
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R31> However it is
debatable whether a child should have a claim for a prenatal injury
against a parent. Otherwise the child may have a claim against its
mother for indiscretions during pregnancy, such as heavy smoking,
drinking, or taking drugs. Even worse would be claims for "wrongful
life" against one's parents, or indeed against a doctor, or the
manufacturer of a defective batch of contraceptives. 32
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R32>

In some Australian states the offence of child destruction prohibits the
intentional destruction of the life of a child capable of being born
alive. "Capable of being born alive" is not defined, although there is
"a presumption that a child is capable of being born alive at 28 weeks
gestation, or it could be earlier". 33
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R33> To date very
few, if any, prosecutions have been brought under this legislation. The
burden of proving a child was capable of being born alive and the
"intent" to "unlawfully" destroy the life of the child would be
difficult.

Despite the law, from an ethical point of view, many doctors feel that
they owe some form of "professional duty of care to the (unborn) fetus".
29 <http://jme.bmjjournals.com/cgi/content/full/31/4/215#R29> If the
fetus is viable and capable of surviving outside of the womb and having
a "separate and independent existence" from its mother, it deserves the
same respect as a child who is born, regardless of how it was created.


CONCLUSION
In Australia and most other western countries it is illegal for an
embryo to be created by manipulating a somatic cell ("Dolly-cloning"),
by fusing an adult cell with an embryonic stem cell, or by any process
other than fertilisation, and allowing that embryo to develop. 34
<http://jme.bmjjournals.com/cgi/content/full/31/4/215#R34> However the
successful cloning of Dolly and other mammals has shown that cloning of
human beings is possible. Regardless of the law, it is only a matter of
time before such human cloning occurs. Such a person, although cloned,
has the same ethical status as any other person, and would be due all
the rights and dignity of any person in our society-legally and
ethically.

Respect for a cloned embryo will only begin when the embryo is
successfully implanted in the womb. Before then, somatic cells in
culture would not be due respect (even though they have the theoretical
potential to become a clone). It is the successful act of implantation
that gives a group of cells the ability to progress to a living human
without further scientific intervention. Respect will gradually increase
throughout the pregnancy as the embryo grows and develops with
nourishment and the right environment, and as its prospects of being
born alive and healthy increase.

Although quickening is an important time for both parents and doctors,
as both become more confident and reassured about the health of the
child to be born, it is essentially subjective. Viability is the time at
which the embryo acquires the same respect as a newborn, its legal
rights being realised upon birth. Once the child is born any time after
viability, it is capable of surviving on its own-separately and
independently of its mother-and in law it is recognised as a person.


REFERENCES

1.	Ford NM. When did I begin? Conception of the human individual in
history, philosophy and science. Cambridge: Cambridge University Press,
1988.
2.	The Royal Society, Anniversary Address 2002 (issued December
2002) .
3.	Tonti-Filippini N . The Catholic Church and reproductive
technology. In Kuhse H, Singer P, eds. Bioethics: an anthology.
Blackwell Philosophy Anthologies 1993.
4.	Congregation for the Doctrine of the Faith. Instruction on
respect for human life in its origin and on the dignity of
procreation-replies to certain questions of the day. Vatican City:
Vatican Polyglot Press, 1987:18.
5.	Uren WJ. How is it right to treat the human embryo? The embryo
and stem cell research. PACIFICA, 2003;16No 2, :2.
6.	Sahih al-Bukhari .(d 870), Sahih al-Muslim (875). The Book of
Destiny [qadar]. In Testimony of Abdulaziz Sachedina, PhD on Islamic
perspectives on research with human embryonic stem cells. Ethical issues
in human stem cell research, religious perspectives. Rockville, MD:
NBAC, 2000;III:G1-G6.
7.	Khalifa AA, Strickland C. Islamic perspective on pro life
issues. Available at <http://abortionismurder.org/quoran.shtml>
(accessed 17 February 2005).
8.	Keown D . Buddhism and bioethics. Hampshire, UK: Palgrave
Macmillan, 2001.
9.	Genetic engineering: genetic manipulation.
<http://www.bloc.co.uk/religion/ethics/abortion/relig-judaism5.shtml>.
10.	Jakobovits I . Jewish medical ethics: a comparative and
historical study of the Jewish religious attitude to medicine and its
practice. New York: Bloch Publishing Company Inc, 274, 1962.
11.	Warnock M . Making babies. Is there a right to have children?.
Oxford: Oxford University Press, 35, 2002.
12.	The Human Fertilisation and Embryology Act 1990, UK and Research
Involving Human Embryos Act 2002, Commonwealth of Australia .
13.	Harris J . The value of life: an introduction to medical ethics.
London: Routledge, 1985.
14.	Tooley M . Abortion and infanticide. In Singer P, ed. Philosophy
and Public Affairs 2. Reprinted in Applied ethics: Oxford readings in
philosophy, 1972;1:82.
15.	Savulescu J . Abortion, embryo destruction and the future of
value argument. J Med Ethics 2002;28:133-5. [Free Full Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=medethi
cs&resid=28/3/133>
16.	Ford N . The prenatal person: ethics from conception to birth.
Oxford: Blackwell Publishing, 2002.
17.	Byrne JA, Simonsson S, Western PS, et al. Nuclei of adult
mammalian somatic cells are directly reprogrammed to oct-4 stem cell
gene expression by amphibian oocytes. Curr Biol 2003;13:1206-13.
[CrossRef]
<http://jme.bmjjournals.com/cgi/external_ref?access_num=10.1016/S0960-98
22%2803%2900462-7&link_type=DOI> [Medline]
<http://jme.bmjjournals.com/cgi/external_ref?access_num=12867031&link_ty
pe=MED>
18.	Research Involving Human Embryos Act 2002, s21(3)(b) .
19.	The New Penguin English Dictionary .
20.	The New Oxford Dictionary of English Oxford: Clarendon Press
1998.
21.	Hansen B , Schotsmans P. Stem cell research: a moral theological
and ethical interpretation. 8. In: Lectures in Medicine. Belgian
Faculties of Medicine, Bruxelles, 2003.
22.	Meyer MJ, Nelson LJ. Respecting what we destroy: reflections on
human embryo research. Hastings Cent Rep 2001;31:16-23. [Medline]
<http://jme.bmjjournals.com/cgi/external_ref?access_num=11478088&link_ty
pe=MED>
23.	Gillon R . Is there a 'new ethics of abortion'? J Med Ethics
2001;27 (Suppl II) :ii5-9. [Abstract/Free Full Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=ABST&journalCode=medethi
cs&resid=27/suppl_2/ii5>
24.	Warnock M . Do human cells have rights? Bioethics 1987;1:1-14.
[Medline]
<http://jme.bmjjournals.com/cgi/external_ref?access_num=11649757&link_ty
pe=MED>
25.	Parliament of Australia, Department of the Parliamentary
Library, Abortion Law in Australia, Research Paper 1 1998-99:8.
Available at <http://www.aph.gov.au/library/pubs/rp/1998-99/99rp01.htm>.

26.	Hewson B . Reproductive autonomy and the ethics of abortion. J
Med Ethics 2001;27 (Suppl II) :ii10-14. [Abstract/Free Full Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=ABST&journalCode=medethi
cs&resid=27/suppl_2/ii10>
27.	Greenwood J . The new ethics of abortion. J Med Ethics 2001;27
(Suppl II) :ii2-4. [Free Full Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=medethi
cs&resid=27/suppl_2/ii2>
28.	Furedi A . Issues for service providers: a response to points
raised. J Med Ethics 2001;27 (Suppl II) :ii28-32. [Abstract/Free Full
Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=ABST&journalCode=medethi
cs&resid=27/suppl_2/ii28>
29.	Wyatt J . Medical paternalism and the fetus. J Med Ethics 27
(Suppl II) :ii5-20.
30.	Hutty Rv. [1953] VLR 338; [1953] ALR 689, Barry J; statutory
definitions to the same effect have been provided by the Criminal Codes
of Queensland, Tasmania, and Western Australia, and also by s20 of the
Crimes Act (NSW).
31.	Watt v Rama [1972] VR 353.
32.	Savulescu J . Is there a "right not to be born"? Reproductive
decision making, options and the right to information. J Med Ethics
2002;28:65-7. [Free Full Text]
<http://jme.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=medethi
cs&resid=28/2/65>
33.	Skene L . Law and medical practice: rights, duties, claims and
defenses. Butterworths 1998:269.
34.	Prohibition of Human Cloning Act 2002 (Cth) s13 .