Last Saturday, in Dublin, an estimated 40,000 people came out to stand in opposition to legalized abortion-on-demand in Ireland.  The abortion issue has simmered in Ireland for years, but the tragic death of Savita Halappanavar in October 2012 has pushed the issue to the forefront of national debate.

As expected, there are those in Ireland, and across the world for that matter, who see this potential development as a sign of progress.  These people believe that a modern Western nation has no business denying abortions to women who want them.  Abortion must be legal and enshrined in law, cherished as a fundamental freedom, and never compromised.

Abortion proponents argue that this is a women’s health issue.  They ignore the fact that pro-life Ireland offers some of the best maternal care in the world – with maternal mortality in the United States (where abortion is essentially available up until the moment of birth) more than three times that of Ireland.  They ignore the fact that Savita Halappanavar died as the result of a strain of E-coli particularly resistant to antibiotics and not due to the failure of doctors to abort her child.  They assert that abortion should be available in cases of suicide ideation or intent, though there is no medical evidence that supports the assertion that abortion is a treatment for suicidality.  To the contrary, abortion has been shown to be the cause of serious mental distress and may cause more psychological distress than carrying a child to term.

Forty years ago, the United States stood on the same precipice on which Ireland now teeters. For this reason, it would be advisable for the Irish government to look towards the U.S. for insight into how legalized abortion impacts a nation.  If they were to do that, they might just see what a long dark road they are considering embarking on.

Legalized abortion was sold to the U.S. as a freedom.  Women would have the right to terminate their pregnancies.  They would make private decisions regarding their health and their lives.  Abortion would be rare, it was thought, and women would be protected.

What has transpired since that time is far from the idyllic vision that was sold to the American people.  Since 1973, more than 54 million children have been lost to abortion in the United States.  That is more than 12 times the population of the Republic of Ireland.

Health is perhaps the most frequent and compelling reason offered for easily accessible abortion.  However, if anything, the “health care” that is offered to women through abortion facilities has only detracted from the proper medical treatment of women.  The Gosnell case in Pennsylvania is the most notorious example of the abortion industry’s abuse of women but there is a long and sad list of women in the U.S. who have been killed or permanently injured as a result of botched abortions, many done ostensibly for health reasons.  Numerous reports of health and safety violations at abortion facilities across the country (noting unsanitary conditions, forced abortions, and appalling medical care) demonstrate that negligence and brutality are prevalent within the industry.

The decision to abort one’s child is not an empowered choice.  It is more often the last choice of the desperate, when the woman feels she has no options.  The purported freedom for women has turned out to be oppressive for them and their children.  If the Irish government wants to seriously address the problem of crisis pregnancies, in whatever form they take, it would be better to focus on ending the crisis and not terminating the pregnancy.

Abortion is a violent and ugly act.  To legalize and institutionalize such violence is a dangerous step whose repercussions may be far beyond what its advocates anticipate – as evidenced by the mess in which the United States currently finds itself.  In the words of John Updike, “Death, once invited in, leaves its muddy footprints everywhere.”  In the United States, we must now fight to resolve this sad situation we have brought upon ourselves and all of its tragic fallout.  Ireland still has a chance to make better decisions and protect its women and children from such a fate.

By Andrea Mrozek

There’s some irony in the passing away of Dr. Henry Morgentaler.  Regrettably, Morgentaler, whose name will forever be connected with opening Canada up to abortion on demand, cannot be celebrated. Making abortion mainstream is something few can celebrate.

Instead, some will celebrate the word “choice.”  This neutral term is now a universal euphemism for abortion.  People will freely say, “I’m pro-choice.”  Yet the term holds in it another irony: That for so many women, abortion was only an answer in the absence of real choice.  The father left, there’s no money, I can’t tell my parents, I can’t cope, we’ll never be able to make it work, and so on.

Abortion is the “choice” in that critical moment in a woman’s life when hope went on holiday.  This is Morgentaler’s legacy: The death of a child, renamed a choice, and without limit in Canada.

He deserves neither all the credit nor all the blame, of course.  When the Supreme Court of Canada heard the now infamous Morgentaler case in 1988, their intention was not to bestow abortion as an unfettered right.  Instead, the court went so far as to acknowledge a legitimate public interest in restricting abortion, and then threw the question back to Parliament — which has been holding the ball ever since.

As a result, we have no law at all and abortion is used in ways it was never intended.  About one-quarter of pregnancies in Canada end in abortion. Initially, for its advocates, abortion was a measure of last resort.  Though statistics are sorely lacking, in Canada we turn a blind eye to more than 100,000 abortions annually.  The genuinely tough cases, don’t make up more than two or three percent.

Though abortion is rare in the third trimester, there is in fact no law against abortion at any time, for any reason.  Doctors and bioethicists acknowledge cases of abortion for cleft palate, for Down syndrome and for other reasons that can only be diagnosed late term. Abortion is also used to eradicate one gender: Women.  While this unique form of barbarism is late to Canada, we do have firm evidence it is happening here.  And in other countries it’s just a matter of counting the millions of missing girls.  Perhaps the richer irony is that in face of this injustice, Morgentaler’s supporters maintain abortion as central to women’s rights.  How can surgically circumventing women’s natural reproductive cycles advance the cause of women’s rights?  How does this advance the lasting well-being and dignity of women? Sex can result in pregnancy.  If carrying a pregnancy to term is a “choice,” it reduces our responsibility to help mothers who face difficult circumstances. Certainly, it’s all the more difficult to justify any number of programs to help mothers if they didn’t have to have children in the first place.  A community can now abdicate responsibility from caring for children by declaring them to be “not my problem,” but rather, “her choice.”

Under choice rhetoric, whether children are punishments or gifts to be welcomed or resented, depends entirely on the woman.  So total is the woman’s right to decide that the other party to the pregnancy — the man — gets only the choice to walk away.  Small wonder then that so many do.

Vicky Green is a social worker living in Ottawa, who has had three abortions, the last one done by Henry Morgentaler.  Vicky told me of how she cried in front of him and said, “I don’t want to do this to my baby.”  To which Morgentaler replied it wasn’t one and she’d have more.

It’s too convenient to simply ignore the life at the heart of the matter.  Ultimately, the choice is whether to keep a child, or not.  There’s a life who, granted, is growing within the woman, but has a heartbeat.  That heartbeat was something Morgentaler chose not to hear.

It’s a dance to celebrate Morgentaler for introducing choice, without referring to the choice itself.  A bit like celebrating Steve Jobs, without ever once mentioning an Apple computer.

And it’s ironic, because for so many women, the abortion clinic is at the end of a road on which all other choices have faded from view.

*Andrea Mrozek is executive director of the Institute of Marriage and Family Canada and the founder of ProWomanProLife.org.  She will be writing for the Lozier Institute from time to time regarding the Canadian experience with abortion policy and other life/bioethics issues.  A version of this article first appeared in the Ottawa Citizen on May 29, 2013.

(Video of Dr. Condic’s testimony can be viewed here.)

May 23, 2013

Chairman Franks, Congressman Nadler, distinguished members of the subcommittee, I am Dr. Maureen Condic, Associate Professor of Neurobiology and Adjunct Professor of Pediatrics at the University of Utah School of Medicine.  I am Director of Human Embryology instruction for the Medical School and of Human Neuroanatomy for the Dental School at my institution. Thank you for this opportunity to testify regarding certain aspects of the District of Columbia Pain-Capable Unborn Child Protection Act (H.R. 1797).

What is Pain?

The experience of pain is complex, with physical, psychological and mental elements.  In the simplest sense, pain is an aversive response to a noxious (physically harmful or destructive) stimulus.  The medical dictionary administered by the National Institutes of Health (NIH) [1] supports this view, defining pain as, “a basic bodily sensation that is induced by a noxious stimulus, is received by naked nerve endings, is characterized by physical discomfort (as pricking, throbbing, or aching), and typically leads to evasive action.”  As humans, we share this basic experience of pain with many other animals, from very simple creatures like reptiles and birds, up to mammals and primates.

Yet pain has more complex dimensions.  The NIH dictionary also offers the following, more nuanced definition of pain: “a state of physical, emotional, or mental lack of well-being or physical, emotional, or mental uneasiness that ranges from mild discomfort or dull distress to acute often unbearable agony, may be generalized or localized, and is the consequence of being injured or hurt.”  This definition also defines pain as a response to a noxious stimulus or injury, but acknowledges that the response can have emotional or mental dimensions as well. And, like all mental experiences, it is difficult for any one of us to fully appreciate another person’s psychological experience of pain.  Every individual’s reaction to pain is unique. Experiences one person might find extremely painful may seem insignificant to someone else. Moreover, even for a single individual, the perception of what is and what is not painful can change over time.  Experiences a young woman might find painful (e.g., being snubbed at a social event) may seem trivial to a more experienced woman in middle age.  And experiences a middle-aged woman might find painfully difficult (e.g., death of a colleague) may be far less painful to a young woman who has a less acute sense of her own mortality.

How do we know if others are experiencing pain?

While the psychological and mental aspects of pain are important to us, they are also fundamentally personal, and therefore not something that can be fully understood by anyone else.  We can listen to someone’s explanation of their painful experience.  We can empathize.  We can measure certain physical, neurological and endocrine responses to painful stimuli.  But we cannot directly share another individual’s experience of pain.

Importantly, our inability to fully understand someone else’s experience of pain does not prevent us from making rational and prudent judgments about painful situations and how they obligate us to behave.  We do not justify inflicting pain on another person by saying, “I can’t possibly know how anyone else experiences me punching them in the face, therefore I am not obligated to refrain from this behavior.”  When considering the pain- experience of other humans, we are guided by three simple principles:  what we know about pain, what we observe about another individual’s reaction to a painful stimulus and what we can reasonably conclude from our own experience of pain.

What we know.  When scientific data provides evidence that an experience causes harm or poses significant risk of harm to another individual (i.e., it involves a “noxious” stimulus), this experience is reasonably viewed as “painful.”  Even if the individual’s perception of this harmful stimulus is compromised in some manner (perhaps by a genetic condition that limits their ability to receive painful neural information or by drugs that have temporarily limited this ability), we are nonetheless obligated to avoid causing pain to another human individual, both out of compassion and out of justice.

What we observe.  When observation, either casual or scientific, provides reasonable evidence that an individual perceives an experience as “painful” (the individual withdraws, cries out, grimaces, or shows elevated respiration, heart rate or stress hormones), we are obligated to avoid causing pain to that individual.

What we experience ourselves.  When our own reaction to the experience another individual is having would be one of pain, we can reasonably conclude it is painful to them as well.  Perhaps not in precisely the same manner or to the same degree, but things that hurt us tend to be hurtful to others as well.

Scientific data regarding fetal brain development and pain perception

The ability to perceive noxious stimuli and react to them develops over a very long period of time in humans, continuing well after birth and (as noted above) changing significantly across any individual’s lifespan.

The earliest “rudiment” of the human nervous system forms by 28 days (four weeks) after sperm-egg fusion.  At this stage, the primitive brain is already “patterned”; i.e., cells in different regions are specified to produce structures appropriate to their location in the nervous system as a whole. [2]  Over the next several weeks, the brain will grow enormously and generate many complex connections, but the overall organization of the nervous system is established by four weeks.  This is significant because it shows that even at this early stage, the brain is not anything like a mere collection of cells or a “blank slate” to be written upon by later developmental processes.  Like all embryonic organs, the structure of the early brain “anticipates” the function of the mature system.

In the region of the brain responsible for thinking, memory and other “higher” functions (the neocortex), the earliest neurons are generated during the fourth week after sperm-egg fusion. [3]  This tells us that at this early date, the brain is organizing the structures that will be required for distinctively human experiences, although these structures will not be fully mature for at least two decades. [4]

There is strong scientific evidence that communication between neurons of the brain is established in the seventh week.  Synapses, which are the molecular structures required for brain cells to communicate with each other, are detected in the cortex at this time. [5]  In animals, synapses are functional immediately and this is likely also true of humans.  Thus, the earliest function of the neocortex as a network appears to commence in the seventh week.

The neural circuitry responsible for the most primitive response to pain, the spinal reflex, is in place by 8 weeks of development.  This is the earliest point at which the fetus experiences pain in any capacity. [6]  And a fetus responds just as humans at later stages of development.

Early synaptogenesis in the spinal cord of human embryos. Milokhin AA. Acta Biol respond; by withdrawing from the painful stimulus.  This simple response is tremendously important for humans at all ages because it rapidly protects the body from harmful events (heat, cold, chemical injury, crushing, cutting, etc.) without requiring the time it takes to reflect on the experience.

The earliest connections between neurons in the subcortico-frontal pathways (regions of the brain involved in motor control and a wide range of psychological phenomena, including pain perception) are detected by 37 days post sperm-egg fusion and are well established by 8-10 weeks. [7]  This indicates that the brain is “wiring” itself in the first trimester, well before reaching the fetal stage of life.  Early establishment of connections between neurons further indicates that brain formation is an active process of progressively building the structures and relationships required for mature brain function.

Connections between the spinal cord and the thalamus, the region of the brain that is largely responsible for pain perception in both the fetus and the adult, begin to form around 12 weeks and are completed by 18 weeks. [8]

The long-range connections within the cortex that some believe to be required for consciousness do not arise until much later, around 22-24 weeks. [9]  And these connections continue to develop for an exceptionally long time.  Indeed, recent studies indicate that the anatomy of the human brain, and therefore the pattern of brain activity underlying all higher functions (reason, memory, emotion, language, etc.), is not fully mature until approximately 25 years after birth. [10]

What brain structures are necessary for a fetus to feel pain?

To experience pain, a noxious stimulus must be detected.  The neural structures necessary to detect noxious stimuli are in place by 8-10 weeks of human development. [11]

There is universal agreement that pain is detected by the fetus in the first trimester.  The debate concerns how pain is experienced; i.e., whether a fetus has the same pain experience a newborn or an adult would have.  While every individual’s experience of pain is personal, a number of scientific observations address what brain structures are necessary for a mental or psychological experience of pain.

First, it is clear that children born without higher brain structures (“decorticate” patients) are capable of experiencing pain and also other conscious behaviors, including smiling, recognizing and distinguishing between familiar/unfamiliar people and situations, having preferences for particular kinds of music and having averse reactions to pain. [12]  This indicates that the long-range connections that develop in the cortex only after 22 weeks (and are absent in these patients) are not obligatory for a psychological perception of pain.  Similarly, experimental animals that have had the cortex removed also show a
vigorous response to painful stimuli, [13] again indicating that late-developing cortical pathways are not required for pain perception and response.

The observations of human decorticate patients and experimentally decorticated animals noted above are consistent with what is known about the representation of consciousness and emotion in the brain.  A recent review from the prestigious “Nature” series states, “Feelings constitute a crucial component of the mechanisms of life regulation, from simple to complex.  Their neural substrates can be found at all levels of the nervous system, from individual neurons to subcortical nuclei and cortical regions.” [14]  Importantly, development of brainstem and thalamic nuclei (among the “subcortical nuclei” mentioned above) occurs quite early in humans, with the earliest spino-thalamic connections forming by 12-18 weeks post sperm-egg fusion. [15]  Similarly, a second recent review concludes that consciousness persists in the absence of “vast regions of the cortex.” [16]

Finally, direct experimental evidence from adult humans contradicts the assertion of ACOG, [17] JAMA, [18] and the Royal College of Obstetricians and Gynaecologists [19] that mature pain perception requires cortical circuitry.  Ablation [20] or stimulation21 of the cortex in humans does not affect pain perception, whereas ablation of lower centers, including the thalamus, does. [22]  These neurological findings indicate that “mature” pain perception is
largely localized to the thalamus.  The spino-thalamic circuits required for pain perception are established between 12-18 weeks post sperm-egg fusion.

What we observe about fetal pain

The preceding sections of this statement have dealt with only the first principle outlined above for how we can determine whether another individual experiences pain; i.e., what we know about the neuroanatomical structures underlying pain perception.  In addition, what we directly observe about fetal pain is very clear and unambiguous.  Fetuses at 20 weeks post sperm-egg fusion have an increase in stress hormones in response to painful experiences that can be eliminated by appropriate anesthesia. [23]  Multiple studies clearly indicate “the human fetus from 18–20 weeks elaborates pituitary-adrenal, sympathoadrenal, and circulatory stress responses to physical insults.” [24]  All of these responses reflect a mature, body-wide response to pain.

Fetuses delivered prematurely, as early as 23 weeks, show clear pain-related behaviors [25] We know less about infants delivered prior to 23 weeks only because so few are available for study.  Strikingly, the earlier infants are delivered, the stronger their response to pain. [26]  These and many other direct observations of fetal behavior and physiology have resulted in a clear consensus among professional anesthesiologists (highly specialized physicians who are experts in pain management) that the use of medications to relieve pain is warranted in cases of fetal surgery. [27]  Many of the advocates of fetal anesthesia make no claims regarding the qualitative nature of fetal pain, but based on both the scientific literature and on their own observations, they clearly conclude that pain exists for these fetuses and that as physicians they are obligated to address fetal pain medically, despite the many serious challenges and medical risks this procedure entails. [28]

Our own experience; why fetal pain matters

As individuals and as a society we must choose the attitude we will embrace regarding fetal pain.  Those who insist, “It is impossible to know what a fetus experiences,” are denying the obvious fact that it is equally impossible to know what any other human individual experiences at any stage of life.  This is not a legitimate argument for ignoring what we know from science and from our own observations.  Similarly, those who insist, “Neuroscientists agree the cortex is required for pain perception,” are denying the ample modern scientific evidence from credible, professional neuroscientists that contradictsthis conclusion.  The absence of a universal consensus regarding what anatomical structures are required for the complex (and personal) psychological experience of “conscious” pain perception does not excuse us from making a decision based on the best  evidence available.

In the end, when considering pain in any other human individual we must choose, based on what we know and what we observe, whether we will give that individual the benefit of the doubt, out of compassion, empathy and justice, or whether we will ignore the pain they experience simply because the precise psychological quality of their pain cannot be known with certainty.  And this choice is as much about the kind of society we want to be as it is about the experience of the fetus.

Imposing pain on any pain-capable living creature is cruelty.  And ignoring the pain experienced by another human individual for any reason is barbaric.  We don’t need to know if a human fetus is self-reflective or even self-aware to afford it the same consideration we currently afford other pain-capable species.  We simply have to decide whether we will choose to ignore the pain of the fetus or not.

From the perspective of neuroscience, it is unclear precisely what “psychological” aspects of a mature pain experience are in place at precisely what point in either human prenatal or postnatal development.  It is impossible for me to know with certainty whether another adult, a teenager or a fetus experiences pain in precisely the same manner I do.  Yet it is entirely uncontested that a fetus experiences pain in some capacity, from as early as 8 weeks of development.  Moreover, most modern neuroscientists have concluded that the thalamic circuitry developed by 18 weeks post sperm-egg fusion is primarily responsible for human experience of pain at all stages of life.

Given that fetuses are members of the human species—human beings like us—they deserve the benefit of the doubt regarding their experience of pain and protection from cruelty under the law.

In light of the scientific facts, the observations of medical professionals, our own experience of pain, and our indirect experience of others’ pain, we must conclude that there is indeed a “compelling governmental interest in protecting the lives of unborn children from the stage at which substantial medical evidence indicates that they are capable of feeling pain.”  And this unambiguously requires a 20-week fetus to be protected from pain, as proposed under H.R. 1797.

Maureen Condic, Ph.D. is an associate scholar of the Charlotte Lozier Institute.

*Minor corrections have been made to the text as it appears at http://judiciary.house.gov/hearings/113th/05232013/Condic%2005232013.pdf.

1 See definition “b” at: http://www.merriam-webster.com/medlineplus/pain.

2 Langman’s Medical Embryology, 11th Edition T.W. Sadler. (2009). Lippincott Williams and Wilkins. (ISBN-10: 0781790697) Chapters 5 and 6.

3 Tangential networks of precocious neurons and early axonal outgrowth in the embryonic human forebrain. Bystron I, Molnár Z, Otellin V, Blakemore C. J Neurosci.  2005;25:2781-92.; ApoER2 and VLDLR in the developing human telencephalon. Cheng L, Tian Z, Sun R, Wang Z, Shen J, Shan Z, Jin L, Lei L. Eur J Paediatr Neurol.  2011;15:361-7.; The first neurons of the human cerebral cortex. Bystron I, Rakic P, Molnár Z, Blakemore C. Nat Neurosci. 2006;9:880-6. Epub 2006 Jun 18.; Development of the human cerebral cortex: Boulder Committee revisited. Bystron I, Blakemore C, Rakic P. Nat Rev Neurosci. 2008;9:110-22.

4 Gogtay N et al. (2004) Dynamic mapping of human cortical development duringchildhood through early adulthood. Proc Natl Acad Sci USA 101:8174; Sowell ER et al. (2003) Mapping cortical change across the human life span. Nat Neurosci 6:309

5 Synaptogenesis in layer I of the human cerebral cortex in the first half of gestation. Zecevic N. Cereb Cortex. 1998;8:245-52.

6 Synaptogenesis in the cervical cord of the human embryo: sequence of synapse formation in a spinal reflex pathway.  Okado N, Kakimi S, Kojima T. J Comp Neurol. 1979;184:491-518.; Onset of synapse formation in the human spinal cord. Okado N. J Comp Neurol. 1981;201:211-9.; The fine structure of the spinal cord in human embryos and early fetuses. Wozniak W, O’Rahilly R, Olszewska B. J Hirnforsch. 1980;21:101-24.;Hung. 1983;34:231-45.; Development of pain mechanisms. Fitzgerald M. Br Med Bull. 1991;47:667-75.

7 Development of axonal pathways in the human fetal fronto-limbic brain: histochemical characterization and diffusion tensor imaging. Vasung L, Huang H, Jovanov-Miloševic N, Pletikos M, Mori S, Kostovic I. J Anat. 2010;217:400-17.; Insights from in vitro fetal magnetic resonance imaging of cerebral development. Kostovic I, Vasung L. Semin Perinatol. 2009;33:220-33.

8 Kostovic I, Goldman-Rakic PS: Transient cholinesterase staining in the mediodorsal nucleus of the thalamus and its connections in the developing human and monkey brain. JComp Neurol 219:431-447, 1983.

9 Functional maturation of neocortex: a base of viability. Gatti MG, Becucci E, FargnoliF, Fagioli M, Ådén U, Buonocore G. J Matern Fetal Neonatal Med. 2012;25 Suppl 1:1013; 3D global and regional patterns of human fetal subplate growth determined in utero. Corbett-Detig J, Habas PA, Scott JA, Kim K, Rajagopalan V, McQuillen PS, Barkovich AJ, Glenn OA, Studholme C. Brain Struct Funct. 2011;215:255-63.

10 Ibid at 4.

11 Ibid at 6.

12 The presence of consciousness in the absence of the cerebral cortex. Beshkar M. Synapse. 2008;62:553-6.; Consciousness in congenitally decorticate children: developmental vegetative state as self-fulfilling prophecy. Shewmon DA, Holmes GL, Byrne PA. Dev Med Child Neurol. 1999;41:364-74.; The role of primordial emotions in the evolutionary origin of consciousness. Denton DA, McKinley MJ, Farrell M, Egan GF. Conscious Cogn. 2009;18:500-14.; Consciousness without a cerebral cortex: a challenge for neuroscience and medicine. Merker B. Behav Brain Sci. 2007;30(1):63-81.

13 Effects of partial decortication on opioid analgesia in the formalin test. Matthies BK,Franklin KB. Behav Brain Res. 1995;67:59-66.; Formalin pain is expressed in decerebrate rats but not attenuated by morphine. Matthies BK, Franklin KB. Pain. 1992;51:199-206.

14 The nature of feelings: evolutionary and neurobiological origins. Damasio A, Carvalho GB. Nat Rev Neurosci. 2013;14:143-52.

15 Kostovic I, Goldman-Rakic PS: Transient cholinesterase staining in the mediodorsal nucleus of the thalamus and its connections in the developing human and monkey brain. J Comp Neurol 219:431-447, 1983.

16 Minimal neuroanatomy for a conscious brain: homing in on the networks constituting consciousness. Morsella E, Krieger SC, Bargh JA. Neural Netw. 2010;23:14-5.

17 Amicus Curiae Brief, American College of Obstetricians and Gynecologists and American Congress of Obstetricians and Gynecologists. Paul A. Isaacson et al., v. Tom Horne No. 12-16670. United States Court of Appeals for the Ninth Circuit.

18 Fetal pain: a systematic multidisciplinary review of the evidence. Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA. JAMA. 2005;294:947-54.19 Royal College of Obstetricians and Gynaecologists, Fetal Awareness: Review of Research and Recommendations for Practice (Mar. 2010).

20 Ibid at 12 and 13.

21 Motor cortex stimulation in patients with post-stroke pain: conscious somatosensory response and pain control. Fukaya C, Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H. Neurol Res. 2003;25:153-6.; Stimulation of the human cortex and the experience of pain: Wilder Penfield’s observations revisited. Mazzola L, Isnard J, PeyronR, Mauguière F. Brain. 2012;135:631-40.

22 Brooks JC, Zambreanu L, Godinez A, et al.: Somatotopic organisation of the human insula to painful heat studied with high resolution functional imaging. Neuroimage 27:201-209, 2005; Nandi D, Aziz T, Carter H, et al.: Thalamic field potentials in chronic central pain treated by periventricular gray stimulation: a series of eight cases. Pain 101:97-107, 2003; Nandi D, Liu X, Joint C, et al.: Thalamic field potentials during deep brain stimulation of periventricular gray in chronic pain. Pain 97:47-51, 2002.; Long-term outcomes of deep brain stimulation for neuropathic pain. Boccard SG, Pereira EA,
Moir L, Aziz TZ, Green AL. Neurosurgery. 2013;72:221-30.; Regional cerebral perfusion differences between periventricular grey, thalamic and dual target deep brain stimulation for chronic neuropathic pain. Pereira EA, Green AL, Bradley KM, Soper N, Moir L, Stein JF, Aziz TZ. Stereotact Funct Neurosurg. 2007;85:175-83.; Penfield W, Jasper HH. Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little, Brown & Co; 1954.

23 Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Fisk NM, Gitau R, Teixeira JM, Giannakoulopoulos X, Cameron AD, Glover VA. Anesthesiology. 2001;95:828-35.

24 Ibid at 22. See also; Human fetal and maternal noradrenaline responses to invasive procedures. Giannakoulopoulos X, Teixeira J, Fisk N, Glover V. Pediatr Res. 1999;45:494-9.; Fetal plasma cortisol and beta-endorphin response to intrauterine needling. Giannakoulopoulos X, Sepulveda W, Kourtis P, Glover V, Fisk NM. Lancet. 1994;344:77-81.; Acute cerebral redistribution in response to invasive procedures in the human fetus. Teixeira JM, Glover V, Fisk NM. Am J Obstet Gynecol. 1999;181:1018-25.

25 Pain behaviours in Extremely Low Gestational Age infants. Gibbins S, Stevens B, Beyene J, Chan PC, Bagg M, Asztalos E. Early Hum Dev. 2008;84:451-8.

26 Determinants of premature infant pain responses to heel sticks. Badr LK, Abdallah B, Hawari M, Sidani S, Kassar M, Nakad P, Breidi J. Pediatr Nurs. 2010;36:129-36.

27 Use of fetal analgesia during prenatal surgery. Bellieni CV, Tei M, Stazzoni G, Bertrando S, Cornacchione S, Buonocore G.J Matern Fetal Neonatal Med. 2013;26:90-5.; Towards state-of-the-art anesthesia for fetal surgery: obstacles and opportunities.  Kuczkowski KM. Rev Esp Anestesiol Reanim. 2013 Jan;60(1):3-6.; Fetal and maternal analgesia/anesthesia for fetal procedures. Van de Velde M, De Buck F. Fetal Diagn Ther. 2012;31:201-9.

28 Anesthesia for fetal surgery. Lin EE, Tran KM. Semin Pediatr Surg. 2013;22:50-5.; Anesthesia for in utero repair of myelomeningocele. Ferschl M, Ball R, Lee H, Rollins MD. Anesthesiology. 2013;118:1211-23.

The central Chinese city of Wuhan has sparked controversy worldwide with the publication of a draft ordinance proposing to fine women who have children out of wedlock up to six times the average annual disposable income.

The legislation is intended to support China’s long-standing family planning policy which limits each couple to one child.  Its stated aim is to keep the cities’ birthrate low.  However, it is feared that fining single mothers would only increase the already astronomic number of abortions and of cases of child abandonment.   

China’s Health Ministry estimates that in the four decades since the imposition of the one-child policy more than 336 million abortions have taken place in the nation.  Numerous human rights groups and news accounts have demonstrated that many of these abortions were forced or coerced.

The proposed ordinance states that an unmarried women who “cannot provide appropriate licenses from her partner,” or who “knowingly bears the child of someone with another spouse,” must pay a “social compensation fee” consistent with provincial family planning laws.  Social compensation fees are often imposed on families who break the country’s strict one-child policy and are usually far more than the average family can afford.

Single mothers have long been stigmatized in Chinese society and illegitimacy is seen as a disgrace to both the mother and the child.  The Chinese government already places a considerable burden on unwed mothers by denying them maternity benefits.

“If the policy is approved, there could be more `sewer babies,’ because when mothers can’t afford the cost, they might think about throwing their babies away,” said Chen Yaya, a researcher at the Shanghai Academy of Social Sciences.

Zhai Zhenwu, director of Renmin University’s School of Sociology and Population Studies, has stated that this proposed ordinance is not unusual in China and that having children outside of marriage is not protected by law.  “Imposing fines on the unmarried who have children is, in fact, a common practice that has been carried out in China for a long time.”

This weekend President Barack Obama is set to meet with Chinese President Xi Jinping.  The meeting is expected to focus on cyber security (especially in light of recent cyber attacks against the U.S.), North Korea, and the global economy.  While all of these issues are important, considering China’s shocking record of human rights abuses, it is essential that this summit and, for that matter, every summit with the Chinese government also address human rights.  In addition to its draconian population control policy which has resulted in forced abortion, gendercide, and, now, this persecution of unwed mothers, China also flagrantly violates its citizens’ right to freedom of the press, religion, association, and expression.

The State Department and President Obama must make it clear that the U.S. finds these abusive policies to be violations of the intrinsic dignity of every human person.  A friendly relationship between our two countries must be contingent upon improvement in China’s treatment towards all its people – wed or unwed.

(Click here for full PDF version of this report.)

This month, researchers at the Oregon Health and Science University published a ground-breaking paper describing the derivation of human stem cells from cloned human embryos.  Despite the minor irregularities that were discovered in the figures (the paper had been rushed to publication after a mere four days of review), the work represents a significant scientific achievement, for the first time presenting credible evidence that human beings have been cloned.

There has been a surprising lack of uproar over this result, perhaps in part due to the less-than- frank reporting of what the researchers actually accomplished.  Nature referenced the controversial result somewhat obliquely, stating, “Human stem cells created by cloning.”  The Scientist was even more misleading, casting the result as an improvement on cellular reprogramming by saying, “New Stem Cells on the Block: By reprogramming human fibroblasts into pluripotent stem cells with somatic cell nuclear transfer, scientists have come up with a viable alternative to iPSCs [induced pluripotent stem cells].”  The popular news media followed suit, with Reuters, CBS News, Fox News and Businessweek all announcing that scientists had produced human stem cells from human skin cells by cloning, conveniently ignoring the human embryos that existed briefly in between.

Let’s be clear:  Cloning is cloning.  This paper reports the generation of cloned human embryos, human beings at the earliest stages of life.  The researchers used a total of 380 human eggs from at least 10 paid female donors to generate cloned embryos, 68 of which survived the seven days required to reach the blastocyst stage of development, before being destroyed to produce human stem cell lines.  It is impossible to know how many of the clones produced were healthy human embryos.  From the poor survival rate of the clones to seven days and the generally poor success for cloning other animals, it seems likely that many of the cells produced by cloning were defective in critical ways.  But in the worst case scenario, 380 embryonic human beings gave their lives for the 18 stem cell lines this work generated.

Which stem cells are the best for research and for medical therapies?

Some scientists will undoubtedly argue that cloning is a necessary alternative to induced pluripotent stem cells (iPSCs) produced by reprogramming.  Many commentators have been quick to point out that there are differences between iPSCs and embryonic stem cells (ESCs).  And they are at least partially correct.  Multiple groups have reported subtle differences between iPS and ES cells.[i]  In contrast, others have found that the two cell types differ only slightly or are essentially “indistinguishable.”[ii]  Comparisons of stem cell lines produced in multiple labs have concluded that differences between laboratory protocols, not between the cells themselves, are  responsible for much of the variation observed between iPSCs and ESCs.[iii]  The bottom line appears to be that iPSCs are roughly as different from ESCs as different ESC lines are from each other, and that better standardization of protocols for generating and culturing pluripotent stem cells would reduce this variation considerably.

Debate over the subtle differences between iPSCs and ESCs tends to obscure the well- documented abnormalities of ESCs themselves.  ESCs are often referred to as the “gold standard” of pluripotency, yet this moniker grossly misrepresents the actual properties of ESCs.  It is inarguably clear that ESC lines are abnormal compared to cells found within the inner cell mass of intact embryos.[iv]  Multiple studies have concluded that ESC lines are quite variable, with many having ‘restricted’ potency and/or strong developmental biases.[v]  Moreover, ESCs have repeatedly been shown to be genetically and epigenetically unstable, accumulating mutations that convert them into cancer cells.[vi]  The same is also likely to be true for iPSCs,[vii] although perhaps to a lesser extent.  In light of the evidence, it is hard to see the ESC “gold standard” as anything other than seriously tarnished.

In addition to the concerns regarding variable potency, unnatural epigenetic state and proclivity to accumulate mutations, ESCs are also “foreign” tissue that would be rejected by the immune system if transplanted to an adult patient.  Consequently, most scientists agree that “autologous” or patient-matched stem cells would be preferable for therapeutic treatments.  The two ways of obtaining patient-matched pluripotent stem cells are reprogramming and cloning.  Thus, it is most appropriate to compare iPSCs to ESCs derived from nuclear transfer (NT-ESCs).  And it is clear that NT-ESCs are at least as problematic for therapeutic applications as both iPSCs and ESCs, if not more so. 

It is entirely undisputed that live-born cloned animals are epigenetically abnormal.[viii]  These abnormalities do not arise as a consequence of gestational irregularities, but are seen at early embryonic stages.[ix]  And direct examination of NT-ESC lines shows that, like the embryos they are derived from, cloned ESCs are also clearly “abnormal” when compared to ESCs derived from fertilization.[x]  Specifically, NT-ESCs carry epigenetic “memory” of the adult cells from which they are derived.[xi]  The same kind of “bias” (i.e., a restriction in potency) is also seen in iPSCs,[xii] and (as noted above at 5) in ESCs derived from fertilization, albeit to a lesser extent than either iPSCs or NT-ESCs. 

In conclusion, all pluripotent stem cell types, (ESCs, iPSCs and NT-ESCs) are abnormal, laboratory-created cells.  They all differ significantly from cells found in intact embryos, and they differ in subtle ways from each other, as well.  They are all prone to genetic instability, accumulating mutations that convert them to cancer cells.  While iPSCs and NT-ESCs are “patient matched,” thereby avoiding the significant complications of immune rejection, both of these cell types carry epigenetic “memory” of the tissue from which they were derived that limits their pluripotency.  Yet in some cases, even ESCs derived from fertilization exhibit poorly understood restrictions in potency that bias them to produce only specific derivatives.  There is not a perfect cell type in the bunch.

Which stem cells should we pursue?

Given the compromises and risks associated with all pluripotent stem cell lines, is it possible to decide which route to pursue, or must research go forward on all fronts until a clear winner emerges?  The problems that have already been identified with all three types of pluripotent stem cells are fundamental (i.e., unlikely to be resolved by simple improvements in technology or more research) and of roughly equal magnitude for ESCs, iPSCs and NT-ESCs.  Any superiority that emerges is likely to involve subtle advantages for specific applications, rather than a clear advantage overall. 

In contrast to the equally compromised scientific credentials of all pluripotent cell types, one contestant emerges as the clear victor on the field of ethics.  Induced pluripotent stem cells do not require the production and subsequent destruction of human embryos.  They do not require the exploitation of women to obtain eggs.  They would not compromise patient health and safety by immune incompatibility.  This does not make iPSCs “ideal,” by any means, but it makes them ethically superior to either conventional or cloned ESCs.   

iPSCs are also clear victors on a technical front.  Reprogramming is a relatively simple procedure.  It does not require researchers to have specialized training or an established relationship with an obstetrics practice to obtain human eggs and embryos.  Scientifically, reprogramming offers a large number of technical advantages that allow researchers to have greater control of the reprogramming process, compared to human cloning.  Because of these desirable features, iPS technology has advanced at a phenomenal pace (see Figure 1).  Indeed, since the advent of reprogramming, the number of papers reporting on research using ESCs exclusively has remained flat, while the number of papers using iPS technology has increased a thousandfold.  Researchers are voting with their feet.  And increasingly, their footsteps are turning to cellular reprogramming as the way forward for pluripotent stem cell research.

Which brings us back to the question of why the news of human cloning was so anticlimactic.  It may well be that the public has simply accepted the concept of therapeutic cloning.  Or that the reporting of this result was so oblique, the public simply didn’t catch on.  But the notably faint praise that greeted this result from the scientific community may also reflect the fact that the field has already moved on.  As one leading stem cell researcher said, “Given the difficulty of obtaining human oocytes, and the controversial nature of the research, embryonic stem cells aren’t likely to ever be the preferred tool of regenerative medicine.”  And that would be even more so the case for cloned human embryonic stem cells.

Figure 1.  (A) Mouse embryonic stem cells  (ESCs) were described in 1981, with human ESCs isolated in 1998.  The Bush administration funding policy announced in 2001, that for the first time allowed the use of federal funds for human embryonic stem cell research, was associated with a rapid increase in the number of publications in this field. 

(B) After reaching a peak in 2008, the number of publications exclusively involving ESCs (animal and human; not iPSCs) has been flat or slightly declining, while the number of papers involving iPSCs has increased a thousandfold since they were first described in 2006.

Maureen L. Condic, Ph.D.  is an Associate Professor of Neurobiology and Anatomy at the University of Utah and an associate scholar with the Charlotte Lozier Institute

In a new video released by commentator William Saletan at Slate magazine, the author critiques videos released by the activist group Live Action regarding clinics that perform late-term abortions.  In those videos, Live Action shows interactions between women whose pregnancies are in the range of 23 completed weeks of gestation.  Saletan critiques the editing of the video to omit points he argues show the clinics in a more favorable light, then states, “Here’s the big thing… even if you didn’t administer an injection, that kills the fetus inside the womb, which nearly all of these clinics do, the mere expulsion of the fetus, even at 21, 22, or 23, weeks is, itself, fatal.  That fetus is not prepared to survive the womb.”

What do established sources say about the survival rates of babies born at various stages of gestation?  These rates are a product of many factors, including the child’s weight, whether the mother took drugs to aid lung development with foreknowledge of an extremely premature birth, the proximity of the prematurely delivered baby to a neonatal intensive care unit and the technical skill of its treatment team.  The Lozier Institute will publish more on this subject in the future but here is one source, the  Eunice Kennedy Shriver National Institute of Child Health and Human Development on the outcomes with babies born in the 22-25 week range in terms of gestation (note that these rates acknowledge that a range of disability occurs in babies born at these ages and that the disabilities decline in both incidence and severity as the gestational age at delivery increases).

Outcomes Only for Mechanically Ventilated Infants in the Sample

**For mechanically ventilated infants, determination of Death/Profound Neurodevelopmental Impairment and Death/Moderate to Severe Neurodevelopmental Impairment based on 3,421 infants whose outcomes were known at 18 to 22 months corrected age; determination of Death based on a denominator of all 3,702 cohort infants.

Fetal development information compiled by the Mayo Clinic acknowledges that, at 23 weeks’ gestation, “With intensive medical care, some babies born this week might be able to survive.”  Thus, even with the application of mechanical ventilation in an effort to save the live of the extremely premature baby, 79 percent of those born at 22 weeks will die before discharge from the Neonatal ICU.  But for the extremely premature baby at 23 weeks the corresponding number is 63% and at 24 weeks it is 41%.  Specialists in the treatment of premature and extremely small neonates cite the thumbnail that over the past 40 years the survivability  for these children has improved by approximately one week each decade.  It is not a fixed number.

Saletan is correct that roughly 1 percent of U.S. abortions are done at these late stages of pregnancy, but the state of U.S. abortion reporting and the likelihood that these late-term abortions are not fully reported must be factored into the assessment.  Even at 1% there would be some 12,000 infants a year in the United States born near, at or after a stage of significant survivability.

Finally, if Saletan were correct that babies in this gestational range cannot and do not survive, there would be no justification for subjecting the woman to the injection of digoxin or another lethal medicine in the first place.  Induction of labor would certainly accomplish the objective of fetal demise.  It is to assure that outcome, or spare the mother the sight and/or sound of her child struggling for life and breath, that prompts the administration of a lethal injection through her abdominal wall.

The Friday, May 3, 2013 Wall Street Journal essay, “Why I Froze My Eggs (and You Should, Too)” astounded me in many ways and left me with an overwhelming sense of sadness for the misguided author, Sarah Elizabeth Richards.  Reading this career woman’s personal account of the tragic “wasting” of her prime dating years in her 20s and 30s, leading her to ultimately spend $50,000 and find herself “lying naked on a cold operating table in a foreign country while a stranger tries to harvest – egg by precious egg – the last of your fertility…” in order to “own her desire to be a mom” makes me wonder where feminism and medicine have gone so woefully wrong.

You see, I am one of those 50-something women who went to medical school in the 1970’s. I was aware that I would spend my “prime baby-making years in the trenches”; however, it never occurred to me to ask for loans to finance egg freezing and tuition.  It never occurred to me that I would ever need to do so in order to “assume control of my fertility” and run the risk of my life “not having unfolded the way (I) imagined.”  I didn’t need egg freezing to motivate me “to take charge of my life,’ in the words of Ms. Richards. 

You see, I was motivated.  I took charge.  It was a choice I made as a young woman. Not awaiting any freezing, I worked very hard through college to be accepted into medical school and then continued to work hard to be the best physician to my patients that I could be.  Family and children?  I met my husband at age 37 over the bed of a lymphoma patient. At age 39, first baby.  Then daughters two and three arrived when I was 40 and 43. However, the idea of children never concerned me until I met the essential part of my family and motherhood: a good husband.

I didn’t spend every date wondering if the guy with the beer in hand was a strong paternal candidate. Did he possess the right genes and desire to have children? I didn’t think about it.  I liked to spend my free time with good, kind, fun and interesting guys.  When I fell in love with the wonderful man I married, then, and only then, did I think of children.  The concept of becoming a family or being a mother, without the inclusion of a father and husband, made no more sense to me than playing baseball without a glove or bat. Moreover, as a physician, I understood about “advanced maternal age” and the risks of pregnancy.  I also saw firsthand the fragility of life and its unpredictability.  If we did not have children, my life with my husband would still have value and purpose.

Regarding the medical issue of freezing eggs, while the advances in infertility treatment over the last decade have been amazing, the harvesting and freezing of eggs, “oocytes,” is not without significant risk to both mother and future baby.  The procedure itself, over $50,000 as Ms. Richards states, involves injecting oneself with hormones to stimulate the maturation of oocytes within the ovaries. These injections carry the risk of infection and the side effects of hormonal manipulation.  The actual surgical procedure itself, starkly described by Ms. Richards, carries the risk of death (from anesthesia), bleeding and loss of ovarian function, infection, and pain.  Moreover, oocytes, unlike the fertilized egg or embryo used commonly in IVF, have a high water content which makes them particularly prone to cryoinjury.  Even in the slow process of thawing, oocyes are less likely to survive (in one prominent study, only 50% of oocytes survived thawing. The percentage of live births approached 21%, not the 60% achieved with fresh eggs in vitro).  This has led the Practice Committees of the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) to conclude that mature oocyte (egg) preservation is a reasonable option for preservation of fertility when medically indicated and embryo preservation is not possible. A history of bad dating partners is not a medical diagnosis; an option to years of regret should not involve a scalpel.

Thus to Ms. Richards and her need for “baby insurance” to “stop the sadness” she experienced as a mid-30s career woman: Having a child does not make one any less sad or unfulfilled. An egg should not be viewed as an “asset.”  Intelligence, a generous spirit and kindness should be seen as assets instead.  Spending years “frittering away your 20s” with a man you would not have children with and “wasting your 30’s with a man who wasn’t sure he even wanted children” is not a prudent decision if motherhood is your goal.  Medicine should not be commandeered to help individuals indulge their insecurity so they can be “in control” An intelligent, independent woman should make choices based on fact – such as the fact that women have less chance of pregnancy as they age.  A 20% chance of a thawed egg leading to pregnancy after the sterile, fatherless decision to harvest those eggs?  I will take my chances with the man and the career I love anytime.

As a female physician I want to be perceived as a doctor first. The years of women proving themselves in the operating rooms and emergency rooms before me paved the way.  Being a mother and having children means that I have maturely and responsibly made a commitment with the man I want to spend the rest of my life with to bring children into this world and raise them, too, as responsible, caring adults.  I shudder that my daughters would enter any relationship with fears of infertility and lack of control as the motivators of their behavior. But alas, for many women today, having children comes down to that one word: control.  “The most powerful gender equalizer of all – the ability to control when we have children,” Ms. Richards intones.  Let me say this, life is full of things over which we have no control.  The chances of conceiving with thawed eggs vs. conceiving naturally diminish greatly as we age – and for a reason.  Pregnancy is a physiologic stress on the female body. An older woman’s circulatory and endocrine systems are more disposed to pre-eclampsia (life-threatening high blood pressure), miscarriage, and diabetes.  Frozen, thawed, or natural eggs: with age comes risk. Medical science should be applauded for making these later-in-life pregnancies safer for both mother and child, but let’s get back to the crux of the matter.

It is time for women to take ownership of their actions and accept the natural consequences.  If I choose a high-powered career in my 20s and pour myself into it as an ambitious man does, then there are sacrifices to be made.  Having children may not be part of the equation. Or I may end up being the oldest mom in the kindergarten mothers’ group. Whatever I choose, freezing eggs to increase the chance of pregnancy when and if I meet the right “sperm donor” totally renounces what motherhood and feminism should be about.  Becoming a mother isn’t all about me – there are three people involved: mother, father, and child.  For centuries this model has held civilizations and family together. When a career woman like Ms. Richards waxes poetic that “no matter what happens in women’s lives – divorce, layoffs, illness, ambivalence – egg freezing can come to the rescue,” we have lost understanding of what motherhood and medicine should be all about. 

Keiren C. Smith, M.D. is an associate scholar of the Charlotte Lozier Institute.

On Monday night, state lawmakers in Vermont approved an assisted suicide bill which will make Vermont the fourth state in the union (one of them by judicial interpretation) to legalize assisted suicide.  Governor Peter Shumlin (D) has said that he plans on signing the bill within a week.    Shumlin has stated that legalizing assisted suicide “gives Vermonters who are suffering from a terminal illness and anticipating excruciating pain peace of mind in knowing that this is an option.”

Once the bill is enacted, Vermont will become the first state to decriminalize assisted suicide through the legislative process.  Physician-assisted suicide is currently legal in Oregon and Washington, where the law was passed by ballot initiative, as well as in Montana, where it was legalized by court order.  A similar bill in Massachusetts was rejected by voters last year. 

Vermont’s House on Representatives voted 75-65 to approve the bill on Monday, after the State Senate came out in favor of it by 17-3 last week.  The bill states that a qualifying patient must be at least 18, a Vermont resident and suffering from an incurable and irreversible disease, with less than six months to live. Two physicians, including the prescribing doctor, must make that medical determination.

The bill has caused a great deal of controversy  in Vermont with pro-assisted suicide groups lobbying vociferously to push assisted suicide through despite the adamant opposition of pro-life, religious, medical, and disabled rights groups.

Dick Walters, president of Patient Choices at End of Life, a pro-assisted suicide group which fought for the bill, called the vote “an important step for champions of terminally ill patient autonomy rights.”

Advocates for assisted suicide argue that giving terminally ill patients the option of ending their lives medically is the most compassionate option and argue for its safety and ethicality. However, as pointed out by Jacqueline Harvey, Ph.D., physician-assisted suicide can lead to serious and unforeseen harm.  There is real concern that the legalization of physician-assisted suicide can lead to the denial of palliative care coverage and adverse impact on the disabled.  Dr. Harvey also points out that there is a real concern about terminally ill patients being coerced into choosing suicide for financial reasons or convenience’s sake. 

The American Medical Association has also remained firm in its opposition to physician-assisted suicide.  Regarding the issue, the AMA states, “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

Dr. Edward Mahoney, President of the Vermont Alliance for Ethical Healthcare, stated, “Democrats and Republicans, medical professionals and disability rights advocates have consistently come together to oppose this ill-conceived and misguided public policy.”  He adds, “This latest bill version is an unrestricted physician-assisted suicide hodgepodge and represents the worst of both worlds; a huge and negative shift in public policy and the way Vermont approaches people with serious illness or disability. It is Oregon-style assisted suicide 2.0.”

It is to be hoped that physicians in Vermont will remain committed to the well-being of their patients and not their destruction.  The American people must discourage attempts to legalize this ethically problematic policy and instead work for ever-improving care for the terminally ill and recognition of the dignity of every human person until natural death.

The horrors revealed at the trial of Philadelphia abortionist Kermit Gosnell have put abortion advocates in a defensive pose. 

Among the charges Gosnell faces are murder in the death of a woman undergoing an abortion, murder in the deaths of four newborns, and performing late-term abortions beyond Pennsylvania’s legal limit for such procedures.

According to testimony, should an infant be born alive during an abortion, Gosnell would “snip” its spine, thus killing the newborn, a grisly variation to get around the federal ban on the equally grisly partial-birth abortion procedure, which calls for puncturing the skull of a born-alive infant and suctioning out his or her brain.

All this explains why one Pennsylvania newspaper has characterized the Gosnell case as “the abortion industry’s worst nightmare.”

To shake themselves out of this nightmare, the abortion industry and its allies are dismissing Gosnell as an “outlier” and “aberration” and in no way reflective of most abortionists and their clinics. 

Whether one accepts that assertion or not, arguments justifying what Gosnell was practicing – late-term abortions and infanticide – are not outliers among abortion advocates.   Indeed, over the past 40 years, at least, such arguments have been made in numerous books, articles and academic journals.

In 1972, one year before the Roe v. Wade decision was handed down, Michael Tooley published “Abortion and Infanticide” in the Princeton University publication, Philosophy & Public Affairs.   In it, Tooley offered an ethical rationale for both.  He expanded on this in a 1983 book by the same name, published by the Oxford University Press. 

In his books Practical Ethics (1979 Cambridge University Press) and Rethinking Life and  Death (1994) Princeton University Professor Peter Singer offers an argument similar, though somewhat different from, Tooley’s in defense of abortion and infanticide. “If we can put aside these emotionally moving but strictly irrelevant aspects of the killing of a baby we can see that the grounds for not killing persons do not apply to newborn infants.”  (Practical Ethics)

Singer also asserts that if there is such a thing as an inherent right to life, or a right not to be killed, then certain animals have a greater claim to it than a newborn human does: “If the fetus does not have the same claim to life as a person, it appears that the newborn baby does not either, and the life of a newborn baby is of less value to it than the life of a pig, a dog, or a chimpanzee is to the nonhuman animal.” (Practical Ethics)

In a 2010 article for the online magazine Slate, William Saletan argued that pro-choice advocates, such as himself, should at least consider imposing limits on abortion from the second trimester on.

This was greeted by a stern rejoinder (among others) from Ann Furedi, the Chief Executive of the British Pregnancy Advisory Service (BPAS), which describes itself as the “UK’s leading abortion specialist.”

Those like Saletan who would have no qualms about early abortions, but question the morality of abortion as the child develops into the second trimester are “shallow” and “fickle.”  Calling such individuals “ethical straddlers,” Furedi asks them: “[I]s there anything qualitatively different about a fetus at, say, 28 weeks that gives it a morally different status to a fetus at 18 weeks or even 8 weeks?”  In her eyes there is not, but rather than seeing this as a reason to protect that life throughout the pregnancy, she takes that as reason to permit abortion, for any reason, throughout the pregnancy.  For Furedi, “the principle of moral autonomy in respect of reproductive decisions” is absolute and demands that women be free to choose abortion for any reason and at any time during the pregnancy.  To deny a woman the ability to do so would be “to strip away her humanity.”   

Sex-selection abortion is also justifiable on grounds similar to Ferudi’s.  On a blog post for BMJ (formerly, the British Medical Journal) Marge Berer, editor of Reproductive Health Matters, writes: “I believe health professionals and everyone who is pro-choice on abortion should support pro-choice doctors and women seeking abortions, whatever their reasons, even when sex selection may be involved.”

In “After-birth abortion: why should the baby live?,” (previously discussed on a posting on this website) published in 2011 in the British Journal of Medical Ethics, the authors, Profs. Alberto Guibilini and Francesca Minerva, answer it shouldn’t.   Just as Ferudi justifies abortion at any stage in a pregnancy by ascribing the same moral status to a 28- week-old fetus to one that is eight weeks or younger, so Guibilini and Minerva ascribe the same moral status to a newborn as to an unborn child.  Thus, they conclude, because an unborn child can be aborted, it is therefore also permissible to kill a newborn in what they call an “after-birth abortion.”

The Guibilini/Minerva paper is moreover a focus of the current (May, 2013) issue of BMJ; indeed the entire May issue is devoted to the subject of infanticide, for and against, and Tooley is among the contributors. 

By the time Profs. Guibilini and Minerva published their article, justifications for infanticide had become so commonplace among those academics who provide the intellectual heft for abortion advocacy that one observer seemed puzzled by the furor the article sparked. 

“…This argument is nothing new. In fact, it’s been around at least since the well-known philosopher Michael Tooley published a paper making essentially the same claims way back in 1972.  …[O]ne presumes the public was outraged because they were hearing for the first time the old news that liberal ‘bioethicists’ support infanticide.  But that just raises the question all over again: What’s so special about this paper?”

In covering the Gosnell trial, ABC cited Vicki Saporta, president of the National Abortion Federation, which claims to set “standards” for abortion clinics.  The problem with Gosnell, according to her, was that he “wasn’t providing care later and wasn’t ensuring fetal demise and not operating under any established standards of care…” 

In other words, Ms. Saporta had no problem with late-term, post-viability abortions – only that Gosnell was performing them in an insufficiently lethal manner.

In light of the gruesome revelations from the Gosnell trial, Saletan again weighed in on the question of late-term and post-viability abortions.  “Is it ok to abort a viable fetus?” Saletan asked.

Absolutely, responded Pema Levy, at The American Prospect.  “For the purposes of Saletan’s question, I think we’re referring to late-term abortions as post-viability abortions, which means that women would be required to continue their pregnancy for 3-4 months.  For me, the answer is yes, late-term abortions should be legal, even if medical complications are out of the picture.”

Abortion advocates may now feign shock to discover there is gambling going on in the casino.

But as Richard Weaver famously wrote, “Ideas have consequences.”

Given all the justifications for late-term and post-viability abortions and for infanticide from pro-abortion academics, public policy advocates and others over several decades now, is it any wonder that the horrors uncovered in Kermit Gosnell’s abortion abattoir happened?

Updated: 5/13/2013

The Food and Drug Administration announced on April 30 that it has approved a drug maker’s application to make Plan B One-Step available over the counter, without a prescription, to girls age 15 and over.  This decision marks a retreat from the previous policy, endorsed by senior Obama Administration officials and President Obama himself, to continue requiring minor children (under the age of 17) to obtain a prescription for this controversial medication.

Prescribing information for Plan B points out that the drug works by “preventing ovulation” or “possibly preventing fertilization.”  Or it may alter the endometrium and thereby “inhibit implantation.”[1]  This refers to implantation of any newly conceived human individual/zygote in the mother’s womb.  Hence, the complete clinical pharmacology of Plan B demands that the drug product be duly recognized as an abortifacient – or potential abortifacient – and not merely described as “emergency contraception.”

Plan B is not only a potential abortifacient, it is also part of a shrewd marketing scheme:  Various studies demonstrate that after a single act of intercourse, without contraception, 7.2 to 8 percent of women may be expected to become pregnant.  In contrast, pregnancy rates among women using “emergency contraception” (Yuzpe method, Plan B, Preven, etc.) are “reduced” to 1.9 percent.[2]  Note what this really says:  Following a single act of unprotected intercourse, fewer than eight in 100 women will actually become pregnant. With Plan B, not more than two of these eight women will become pregnant — meaning the product is only about 75% “effective.”  By exploiting fears of pregnancy after non-contracepted sex (among, say, 100 women), the manufacturers of Plan B and similar drug kits can sell their product to 100 buyers, including 92 who don’t even “need” it, and 94 who derive no benefit.[3]

Talk about a massive consumer over-sell.

More importantly, however, how many girls and women will be harmed by taking high dosages of steroid hormones (1.50 mg levonorgestrel per tablet, Plan B One-Step), and with the potential for multiple exposures between menarche and menopause?[4]  Levonorgestrel is a totally synthetic progestogen.[5]  Once ingested, the potency of synthetic hormones may be much greater than their measurable concentrations suggest.[6]  Per Stanczyk, conjugated progestin metabolites, such as sulfates of levonorgestrel, which are inactive, may form “circulating reservoirs” from which biologically active progestins may be obtained.[7]  Stanczyk also observed that scientists still know “relatively little” about the pharmacokinetics of artificial progestins, which is “surprising in view of the widespread … use of these compounds.”[8]

Ironically, veterinarians and dairy farmers have known for years that progesterone (the only natural progestin) typically down-regulates uterine immune functions and prevents the mammalian uterus from resisting infections.[9]  Are we really supposed to believe that there will be no adverse effects among women who ingest levonorgestrel and other synthetic progestogens — many repeatedly over the course of their reproductive years?[10]  The deaths of women who took RU-486 and developed septic shock due to infection with Clostridium sordellii may be all the red flag we need.  After all, these deaths underscore the risks associated with ingesting artificial hormones that block the body’s progesterone and glucocorticoid receptors and alter the hypothalamic-pituitary-adrenal axis.[11]

Which reminds me to get back to plain English: Regardless of potential immune system effects, it is already established that levonorgestrel and other synthetic steroids induce endocrine-disrupting effects.  Indeed, they are sold and consumed precisely for their endocrine-disrupting effects.  The normal outcome of sexual intercourse in a healthy, fertile female may indeed be pregnancy.  Thus, Plan B and other forms of “emergency contraception” are designed to thwart the normal functioning of the female endocrine and reproductive systems, beginning with – and, indeed, targeting — the brain.

Few if any young women who rush to purchase Plan B (or Preven, etc.) from their local pharmacy within 72 hours of “unprotected sex” are thinking about the systemic effects of such drugs.  These young women are not thinking about their hypothalamic-pituitary-gonadal axis (their brain, bloodstream, and bodily ecosystem), nor are they thinking about potential long-term effects of exposure to hormonally active compounds.  Instead, these young women are likely not to be thinking critically at all – certainly not about the long term.  Fearful if not panic stricken, they are being exploited for financial profit – all while being exposed to well-documented risks of infectious disease and emotional and psychological harm associated with non-marital sexual activity.

Lastly, if references to a profit motive among Plan B advocates might seem a bit unfair, here I note that in July 2006, when Food and Drug Administration officials announced that the FDA was “reconsidering” limits on over-the-counter sales of emergency contraception (then to women over age 18), shares in Barr pharmaceuticals climbed $2.42, or 5 percent, to $51.25 in morning trading alone on the New York Stock Exchange.[12]

As of this writing, stock prices dipped slightly on May 1 for Teva Women’s Health, the Barr subsidiary that now markets Plan B One-Step.  However, an article in Bloomberg business news earlier this year noted that Teva plans on $460 million to $500 million in “women’s health sales” in 2013 alone.[13]  Such facts prompt the question: Cui bono? Who benefits?

As the saying goes: Let the buyer beware.

Teresa A. Donovan, MPH is an associate scholar of the Charlotte Lozier Institute.