Diverging views

The status of the human embryo is central to debates on the ethics of genetics, embryo research, infertility treatment and post-coital contraception. Among Christians there has been disagreement throughout history, and the matter has been hotly debated before in CMF, both in the Journal of the CMF [1,2] and in Nucleus[3,4]

The CMF Abortion Survey[5] published in 1996 revealed a variety of views among the 2,580 doctors and 348 student members who responded. 36% of doctors and 68% of students believed human life had 'full value' from the time of fertilisation (by 8 weeks gestation these figures had risen to 85% and 92% respectively). However, the way these views were expressed in practice seemed inconsistent; only 20% of doctors and 50% of students said they would refuse to use methods of contraception which might act by preventing implantation.

The issue is of crucial importance. If we believe that human embryos are human beings worthy of the utmost respect then we will have very serious reservations about abortifacient contraceptives, embryo research and experimentation, some infertility treatments and pre-implantation diagnosis. If we see embryos as less than fully human we will be more accepting of these practices in difficult circumstances.

The personal cost

To take a stand on this issue can be very costly for our careers and reputations; because while doctors once accepted that life should be shown 'the utmost respect from the time of conception',[6] this is no longer the case. A profession that actively collaborates in performing 180,000 abortions each year in England and Wales alone is not going to have qualms about tipping embryos down the sink or inserting IUCDs! Under the Human Fertilisation and Embryology Act it has been legal since 1991 to freeze, experiment upon and dispose of human embryos up to the age of 14 days and about 280,000 have succumbed since.

If we don't go along with our colleagues many of them will see us as actively obstructing good medical practice. It is therefore not surprising that when the pressure is on, some Christians change their beliefs.

My own personal view is that human embryos are not just potential human beings but rather human beings with potential. The obvious corollary is that I believe we should treat embryos with the same respect that we treat other human life. I have not always thought this way; and I know that many reading this article will not share my current beliefs so I want to examine some of the objections that have been raised to this view both outside and within the church.

Secular objections

There are many reasons given by secular philosophers and biologists as to why embryos are not 'fully human'. Let's look at some of the arguments marshalled in support of this view, and some possible rejoinders to them. Some of these arguments are mutually inconsistent:

1. Embryos lack rationality

Most medical ethicists today say that not all human lives are 'persons'. Doesn't being a 'person' mean having a certain degree of rationality or capacity for relationship?

This was the thinking behind the Warnock Committee's recommendation of no embryo research beyond 14 days, as the neural crests first form 10 days after fertilisation. Others have suggested that breathing movements (12 wks), or 'quickening' (20wks), or even the first breath of air should be the end point. But even a newborn baby's rational capabilities are limited and our own rationality is extremely limited when compared with God's. In fact the development of the nervous system is a continuous process beginning at fertilisation. Isn't choosing an arbitrary point on the continuum simply discriminating on the basis of intellect; isn't it being 'intellectist'? And why the nervous system? Why not the gastrointestinal system or cardiovascular system?

Our value as human beings does not consist in our capacities or attributes but in the fact that we are human. We do not even have to know God, it is sufficient that he knows us. Human value is bestowed by grace by virtue of being made in God's image (Gn 1:27, 9:6). Dividing human lives into persons and non-persons (or potential persons) smacks of Nazism.

2. Many embryos die

Early embryos have a high mortality; about 40-70% don't reach maturity. Doesn't this indicate that they can be regarded as more expendable?

Is the value of human beings contingent on their survival rates? We don't say that Sudanese refugees or Chinese flood victims are less important simply because they have a high mortality. If survival rates at any stage of development are low this does not justify us ending life. The general strategy of medicine is rather to save and preserve it.

The figure of 40-70% may well be an overestimate anyway. No-one really knows how many early embryos die as there is no biochemical marker for fertilisation, as opposed to implantation.

3. Many embryos are abnormal

Embryos that do spontaneously abort have a high incidence of genetic (particularly chromosomal) abnormality. Can we really regard these as being fully human?

Why not? All of these abnormal embryos have formed from the union of two human gametes. Aren't they therefore just human lives with severe handicap, or even human lives with special needs? We would not dare say in any other sphere that the value of any particular human lives was contingent on their level of normality; far less that abnormality justified killing.

4. Sperm and ova are equally human

Sperm and ova are alive and human but we don't treat every sperm as sacred; so why should an embryo, which after all is not much further along in development, be fully human?

The difference is that an embryo is a genetically distinct living organism, already with a unique genotype and the ability to grow into an adult. Sperm and ova are not. They are simply haploid cells; with no inherent capacity, in themselves, to grow and divide.

5. Hydatidiform moles are not human

Some products of conception, for example hydatidiform moles, are not human organisms. Isn't there then a continuum in nature from non-humanity to humanity?

It may have seemed so in the past, but now we know that a hydatidiform mole is formed not from the union of male and female gametes but rather from two male gametes. It is not technically a 'product of conception' at all.

6. Conception is a process

Conception is a process which is not complete until the first cell division or implantation, so why could the process not be interrupted justifiably before it is complete?

Isn't organogenesis, or the development of the nervous system, or indeed life itself equally a process? Where does one draw the line? Isn't it better not to intervene in any process that has already started? Regarding implantation, how can we say that the value of any human life depends on its place of residence or degree of independence? Isn't that once again discriminating?

7. Much of the embryo is redundant

Not all tissue derived from the fertilised egg ends up in the embryo (ie some becomes yolk sac etc). Does this not imply that the embryo is something different than a human being?

Maybe, but this makes the embryo something more than a human being rather than something less. The cells that are destined to produce the adult are contained within it. Should we not then show the embryo extra respect in case we damage any component of it which is destined to be part of the complete organism; or endanger the latter's nutrition or support? To claim that we can take our 'pound of flesh' with impunity is to attempt 'Shylock's task'. The 'conceptus' is surely best left alone.

8. Some embryos twin

Monozygotic twins make up 3 to 4 of every 1,000 births and usually divide at the embryo stage between 3 and 14 days after fertilisation. Doesn't it then make sense that each of those individuals had their origin at the stage of division rather than fertilisation and that therefore all individuals have their origins after fertilisation?

We have to admit that it is difficult to conceive of two individuals inhabiting one body; but it does not follow that what we find difficult to conceive of cannot therefore be the case. As Christians we believe that three persons constitute one Godhead. We also maintain that Siamese twins (although one body) are two persons. There are clearly two embryos with two destinies in the embryo that twins. We have already said that the embryo is more, not less than, a single human life.

9. We don't treat embryos as human

We don't recognise embryos as human because we already use post-coital contraception which endangers their survival. Doesn't this in itself imply that they are not actually fully human?

We must remember that our intuitions change with time and vary across and within cultures. They only tell us about what we do or don't believe, not about the way things really are. The laws about embryo research in Britain are among the most liberal in the world and run counter to traditionally accepted ethical codes. Rather than letting our practice determine our principles, shouldn't our principles determine our practice?

Some Christians have used this argument to say that those who claim the embryo should be respected are hypocritical, because in reality we don't respect embryos; for example we don't mourn their loss in the same way or baptise them. However, our value does not depend on how others may value us or miss us when we are gone. It depends on what God thinks of us. Baptism may raise ethical dilemmas for strict paedobaptists, but it seems to me that the best way of showing respect to an embryo is to leave it undisturbed in the safety of the womb.

'Christian' objections

Christians will often employ the above 'secular' arguments to justify embryo experimentation or post-coital contraception; but have 'biblically based' arguments of their own as well.[7] Let's look at the most common ones:

1. The Bible teaches that embryos are less valuable

This is an important argument to consider because it dominated thinking within CMF for decades, and church teaching for centuries. The argument is based on an unjustified interpretation from Exodus 21:22-25 and because space does not allow a full consideration of the arguments here, readers are referred to more detailed accounts elsewhere.[8,9,10]

In short, the verses have been misinterpreted in two ways by earlier CMF and by the church.

Thinking within CMF was based on the AV and RSV translations of the original Hebrew which implied different punishments for the accidental killing of a mother (death penalty) and her unborn child (a fine). The conclusion was that God himself apportioned different values to mother and fetus. The NIV translation, by contrast, implies that the death penalty was for fetal or maternal death, and the fine was for injury without fetal or maternal death. This latter interpretation is now accepted as the correct one by most contemporary scholars.

Even if the former interpretation was correct, the fact is that the text deals with accidental, not deliberate, killing. It's also noteworthy that killing slaves was not a capital offence in the Old Testament despite the fact that slaves were as important to God as anyone else. We cannot therefore infer from this text that the early fetus or embryo is worth less in the eyes of God; or that it can be justifiably killed.

The medieval church based their interpretation of Exodus 21 on the Septuagint (Greek Old Testament) rather than the original Hebrew. The Septuagint translation states that the fine or death penalty was determined by whether or not the (dead) fetus was 'formed' or 'unformed'. The Hebrew says nothing of the sort, but the error led astray even Augustine and Aquinas before it was later recognised.

As a result of this, the fetus has been accorded full status only in the first two centuries of church history, and latterly within the last century or so. There is nothing else in Scripture that even remotely suggests that the unborn child or embryo is anything other than a human person from the moment of conception. Rather the event of 'conception' is mentioned explicitly over 60 times in the Bible, and the references to life before birth are legion (eg see Gn 25:22-23; Ps 22:9,10, 51:5, 71:6, 119:73,139:13-16; Ec 11:5; Is 49:5; Je 1:5; Ho 12:3; Mt 1:18).

2. The image of God was lost at the Fall

Human beings are made in the image of God, but Christians are being conformed to the image of Christ, who is himself God. Does this mean that the image of God was somehow lost at the Fall? Many Christian thinkers have thought so and some have suggested that some human beings may have less of the image of God than others. Not surprisingly, the embryo has been one such casualty. But this ignores the fact that the death penalty for murder (killing an innocent human) being was instituted after the Fall (Gn 9:6), and was based on the fact that man was made in God's image. Even if we accept that the image of God was damaged in the Fall, this still gives us no basis for killing innocent human beings in any circumstance at all.

3. The embryo doesn't have a soul

When does the soul enter the body? Is it some time after fertilisation, and if so is it justifiable to kill an early embryo on the grounds that it doesn't possess a soul? Some Christians have said that human beings can be divided into body and soul but this is based on the ancient Greek idea of body and soul being separate entities; a notion which finds no support in the Bible. While it is true that all human beings survive death and face judgement (Heb 9:27), our destiny is to be clothed in a 'resurrection body' (Phil 3:21). The biblical word 'soul' (Gn 2:7) includes the body. We have bodies and are souls, rather than the other way round.

Some have argued that Jesus himself entered his body after conception on the basis of Hebrews 10:5 (which says 'a body you prepared for me'), but the plain reading of Christ's incarnation is that he was present in Mary's womb from the time of conception (this was the time that John the Baptist leapt in the womb!) If he was 'made like us in every way' then surely the implication is that we started at conception too. While it is true that we were 'chosen in (Christ) before the world was made', (Eph 1:4) this does not however equally imply that we were pre-existent in the same way that Christ was. The fact that God 'knew (or equally chose)' Jeremiah before he 'formed (him) in the womb' (Je 1:5) does not mean that Jeremiah therefore existed before he was conceived. Those who do take this latter view (unjustifiably to my mind) should be against contraception to be truly consistent. This issue has been adequately dealt with elsewhere.[7]

Conclusions

I am personally unconvinced by the secular and 'Christian' arguments for the embryo being less than fully human. It is true that we cannot look up 'embryo' in a concordance nor find anywhere in the Bible a verse directly stating something along the lines of, ''Human embryos are fully human and must be treated as such', says the Lord'. But the Bible is nonetheless given that we may be 'thoroughly equipped for every good work' (2 Tim 3:16) and God placed his unchanging principles in it in order that we might apply them to new situations. The issue of the status of the embryo did not arise in biblical times, simply because the technology that has made it an issue for us had not been developed.

I am not suggesting that we rely on 'prophetic' words for guidance (as a friend of mine did in hearing the Lord bless the IUCD with the words of Acts 11:9), nor that we seek ex cathedra announcements from church hierarchies. I am suggesting rather that the arguments for devaluing the embryo are unconvincing, and that in the light of the biblical testimony on life before birth we should give the embryo the benefit of any doubt that we think still exists (Ec 11:5). Unless we can be sure that the embryo is not fully human, then surely we should show it the utmost respect (Rom 14:23), whatever the personal cost may be.

This issue of the status of the embryo is crucially important. All of us have to make decisions about what we will and will not do as Christian doctors; and all of us will be asked for advice by Christian friends about contraception and infertility. We have to know where we stand so that we can 'give an answer... with gentleness and respect'.