In her recent article (JAMA, Oct. 21, 1992) Dr. Stotland attempts to argue that post-abortion trauma is a "myth" and factually "non-existent". Clearly, she comments, more unbiased and expanded empirical studies need to be conducted in this area before the issue can be satisfactorily resolved.
I am not a trained psychiatrist. However, as a former biomedical researcher and present philosopher and bioethicist, I would like to suggest one possible source of Dr. Stotland's denial of such a trauma - i.e., the denial (by many of us) of the actual status of what it is that is aborted. It would seem that this is critical to any factual understanding of adverse reactions (however psychiatry would categorize them) several years after the abortion event. I applaud Dr. Stotland's desire to "bring the discussion into the scientific medical literature", yet there must be an unbiased effort to be truthful and consistent in acknowledging in that literature what are "facts" and what are "myths".
Many of us have been thoroughly convinced by the scientific (and the bioethics) literature itself (before the fact of abortion) that the human embryo or human fetus is either not a human being, or if it is, that it is not a human person.1 If either is factually the case, the decision of a woman to abort or not to abort her unborn child is a priori made considerably more justifiable and "rational".
Elaborate scientific arguments have been flooding the biomedical literature for some years now, positing such scientific claims as: the human embryo or human fetus is just a "blob" or piece of the mother's tissues; that all of the genetic information specific for a human being is not present at fertilization; that human embryos can give rise to teratomas or hydatidiform moles and therefore are not "human"2; that all of the cells from the 5-6 day embryo trophoblast layer are discarded after birth and therefore it is really a "pre-embryo", that totipotent cells can each develop into later individual human beings, and that twinning can not take place after 14 days - and therefore the early human embryo is not a true "individual", and therefore not a true human being yet3; that full differentiation is completed by 14 days4; and that true "personhood" is not present until "brain-birth", i.e., the formation of the nerve-net, neocortex or whole brain integrating system.5
If such "medical facts" (and others like them) were actually true, it is small wonder that not only young teen-age girls and younger women, but also boy friends, husbands, parents, grandparents, priests, ministers and councilors, physicians, nurses, researchers, public policy makers, Supreme Court Justices - and yes, even psychiatrists - have bought into such "scientific" claims which are really, themselves, in fact, "myths" and "non-existent". Surely such scientific misinformation has bolstered at least temporarily their firm convictions that the early human embryo or human fetus is not really a human being or a human person, and therefore disposable or insignificant in contrast to the autonomous rights of "women who become pregnant under problematic circumstances". Unfortunately, these "scientific facts" in the biomedical literature are virtually all incorrect; yet I do not hear Dr. Stotland calling for an objective purging of these "myths" from the biomedical and bioethics literature in the name of scientific accuracy and the physician-patient relationship. Why?
The real scientific facts are the following. To determine if the human embryo is a human being, all one has to do is count the number of chromosomes in any cell of that human embryo or human fetus under a microscope, and observe the functions and activities which are present immediately after fertilization. It is immediately observed empirically that the early human embryo and human fetus is not a "blob" or piece of tissue of the mother. When the 23 chromosomes of the sperm and the 23 chromosomes of the ovum are combined, a new, unique living individual with 46 chromosomes (the number and quality specific for the human species)6 is formed. Although this means that the human embryo is a human being, the chromosomal make-up of the human embryo and fetus is qualitatively different from that of either the mother or the father. That is, the genetic identity of the human embryo is different from the genetic identity of the tissues of the mother or the father. Thus the human embryo or fetus is not only a human being, it is clearly not, scientifically, just a "blob" of the mother's tissues.
Furthermore, at fertilization the human embryo is already a male or a female; immediately specifically human enzymes and proteins are formed; specifically human tissues and organs will be formed (not cabbages or giraffes).7 Virtually all of the genetic information the human being will ever have or need is present immediately at fertilization. No genetic information is gained or lost throughout development -only the use of some information is lost through mechanisms such as methylation.8
This original genetic information then "cascades" throughout the course of human development, continuing to determine specifically human molecular information, tissues and organs.9 All of the genetic information is there that will ever be needed during growth and development, including the genetic information needed for differentiation,10 totipotency (which is quite normal) and all of the processes of embryogenesis - sometimes even twinning. Entities such as teratomas and hydatidiform moles do not arise from genetically normal human embryos, but from abnormal embryos to begin with (e.g., dispermy).11 All of the cells from the trophoblast layer are not all discarded after birth, but many from the yolk sac and allantois are incorporated into the embryo-proper as the early blood cells and the primordium of the primitive gut, and in the human adult as the median umbilical ligament and blood cells.12 Twinning is possible after 14 days, e.g., with fetus-in-fetu and Siamese twins.13 And there is no scientific physiological basis for a valid parallel between "brain death" and "brain birth", sentience or self-consciousness.14 Interestingly, full human development is not complete until after 20 years of age,15 and full brain integration and the actual exercising of "rational attributes" are not present until several years after birth.16
Thus any arguments about physiological "preconditions" for either sentience or rational attributes are themselves arguments from potentiality, and actually depend physiologically on the precondition of the single-cell human zygote itself. It should be carefully noted that if either actual sentience or rational attributes are indeed the rationale for human "personhood", then newborns, young children, Alzheimer's and Parkinson's patients, alcoholics, drug addicts, the mentally ill and retarded, the depressed, comatose patients, and paraplegics (to name but a few) are not "persons" either, and thus, by the very same logic, could be "disposed of".
The position that the early human embryo and human fetus is not a human being or a human person, then, is itself scientifically and medically a "myth". Such incorrect medical information should be brought out into the "light" of professional scientific scrutiny as well as any information concerning the "myth" of post-abortion trauma. Yet how many physicians, or psychiatrists, are willing to "provide [this] sound scientific information [to their patients] to help them make informed decisions about health issues"? Not many. Why not?
Yes, Dr. Stotland is correct to note the increase in the conflict concerning abortion, especially since the Roe vs Wade decision. But she implies that religious and personal opinions which reject abortion are factually misplaced and are being imposed on women who have the absolute autonomous right to choose whatever they want in regard to their unborn child. She also implies that these irrational (because personal and/or religious) claims about post-abortion trauma are hampering the physician's and the psychiatrist's role to "counsel, advocate for, and treat individual patients on the basis of medical knowledge and in the patient's best interest".
Yet Dr. Stotland refuses to consider that she is dealing here with two patients - the pregnant woman and the unborn child. She does not see any need to consider the best interests of the unborn child, and she counsels her pregnant mother on the incorrect embryological facts, so that the mother in turn could never make a truly informed decision about aborting her child - thus precluding any meaningful autonomy or informed consent at all. Why?
Consider the possible consequences of such a physician-patient relationship. Dr. Stotland conveniently refuses to consider that perhaps some personal opinions and some religious convictions are actually rooted in non-relative, objective facts. (For example, the human embryo and the human fetus are human beings.) And perhaps the aborting woman does not know them or want to know them at that moment. Yet later she does learn these correct embryological facts, even years after the abortion. Or perhaps the woman eventually puts two + two together in some other indirect way. That correct embryological information, coupled with a religious commitment to respect all innocent human beings (regardless of their race, sex, disabilities, nationality - or size), could conceivably trigger such a "traumatic" event as post-abortion syndrome in the mother who has previously naively autonomously aborted what she thought at the time was just a "blob" of her own tissue.
If she has also donated her aborted unborn child for fetal tissue transplant research or for human embryo research, perhaps she could also come to the realization of another medical "fact" - that her fetus was not dead or anesthetized when his or her brain cells were removed for tissue transplant "therapy" or when her embryo was sacrificed in destructive human embryo research for "the greater good". These medical "facts" should also be constitutive of any realistic physician-patient counseling or relationship - and yet they are not. Why?
An aborted woman could also come to the gradual realization that a woman's - or any other human being's - "pure absolute autonomy" is also a "myth". Certainly the field of bioethics is finally beginning to come to grips with that dialogue. No one - male or female - has an absolute right to choose absolutely anything just because conditions are difficult or a mistake was made. Our choices are always qualified; and our choices always have consequences - with which we must all live.
Finally, I respect Dr. Stotland's concern about what has come to be identified as a "woman's issue". I myself am a professional woman, and I know perfectly well that women have been the subject of serious and unjustified abuse and discrimination. However, this does not condone the current "rationalization" and legalization of everything and anything, simply because many women "want" it. Abortion is, in fact, ultimately an aggression against women. The sooner women acknowledge that fact the sooner more realistic and objectively based counseling of women in "problematic" situations can be provided by physicians and psychiatrists alike.
In sum, Dr. Stotland should not be so selective about which "facts" to explore in the biomedical literature. Nor should she be so quick to selectively accept as "facts" things which are in fact "myths".
1 But see Irving DN. Philosophical and Scientific Analysis of the Nature of the Early Human Embryo. Doctoral dissertation, Department of Philosophy, Georgetown University, Washington, D.C.:1991; Irving DN. Scientific and philosophical expertise: an evaluation of the arguments on fetal personhood. Linacre Quarterly. Feb. 1993 (forthcoming); Irving DN. The impact of scientific misinformation: philosophy, theology, biomedical ethics, public policy. Accountability in Research. Feb. 1993 (forthcoming); Carberry J, Kmiec DW. Abortion: how law denies science. Chicago Tribune. July 14; Fisher A. Individuogenesis and a recent book by Fr. Norman Ford. Anthropotes. 1991:2:199; McCullagh P. The Foetus as Transplant Donor: Scientific, Social and Ethical Perspectives. New York, John Wiley and Sons:1987. [Back]
2 Bedate C, Cefalo R. The zygote: to be or not be a person. Journal of Medicine and Philosophy. 1989:14:6:641. Also Bole J.T. Metaphysical accounts of the zygote as a person and the veto power of facts. Journal of Medicine and Philosophy. 1989:14:647-653, and Zygotes, souls, substances and persons. Journal of Medicine and Philosophy. 1990:15:637-652. [Back]
3 Grobstein C. The early development of human embryos. Journal of Medicine and Philosophy 1985:10:213-236. Also McCormick R. Who or what is the preembryo? Kennedy Institute of Ethics Journal. 1991:1:1-15. [Back]
4 Ford N. When Did I Begin?. New York: Cambridge University Press: 1988:137, 156. [Back]
5 Jones DG. Brain birth and personal identity. Journal of Medical Ethics 1989:15:4:173-178; MacKay D. in Jones 1989; Rahner, Ruff and Haring, in Jones 1989; Sass H. Brain death and brain life: a proposal for normative agreement. Journal of Medicine and Philosophy 1989:14:45-59; Singer and Wells, in Jones 1989; Tauer C. Personhood and human embryos and fetuses. Journal of Medicine and Philosophy. 1985:10:253-266; Lockwood M. Warnock versus Powell (and Harradine): when does potentiality count? Bioethics 1988:3:3:187-213; Goldenring J. Development of the fetal brain. New England Journal of Medicine. 1982:307:564, and The brain-life theory: towards a consistent biological definition of humanness. Journal of Medical Ethics 1985:11:198-120; Kushner T. Having a life versus being alive. Journal of Medical Ethics. 1984:10:5-8; Gertler, in Singer P. Practical Ethics. London, Cambridge University Press: 1981; Bennett MV. Personhood from a neuroscientific perspective. in Doerr et al. Abortion Rights and Fetal "Personhood". Long Beach, Cresline Press:1989. [Back]
6 Moore KL. the Developing Human. Philadelphia:W.B. Saunders Co.:1982:14; Lewin B ed. Genes III. New York: John Wiley and Sons:1983:9-13, 386-394, 401; Emery AEH. Elements of Medical Genetics. New York: Churchill Livingstone:1983:19, 93; also obvious from the following research: Gordon K et al. Production of human tissue plasminogen activator in transgenic mouse milk. Bio Technology. 1987:5:1183: Weishous T et al. Secretion of enzymatically active human renin from mammalian cells using an avian retroviral vector. Genes. 1986:45:2:121-129; Tanaka A, Fujita D. Expression of a molecularly cloned human C-SRC oncogene by using a replication-competent retroviral vector. Molecular and Cellular Biology. 1986:6:11:3900-3909; Schnieke A et al. Introduction of the human pro alpha 1 (I) collagen gene into pro alpha 1 (I) - deficient Mov-13 mouse cells leads to formation of functional mouse-human hybrid type I collagen. Proceedings of the National Academy of Science - USA. Feb. 1987:84:3:764-768; Hart C, Awgulewitch A et al. Homeobox gene complex on mouse chromosome II:molecular cloning, expression in embryogenesis, and homology to a human homeobox locus. Cell. 1985:43:1:9-18; Kollias G et al. The human beta-globulin gene contains a downstream developmental specific enhancer. Nucleic Acids Research. July 1987:15:14:5739-47; Olofsson, B, Pizon V et al. Structure and expression of the chicken epidermal growth factor receptor gene locus. European Journal of Biochemistry. 1986:160:2:261-266; Saez L, Leinwand S. Characterization of diverse forms of myosin light chain gene: unexpected interspecies homology with repetitive DNA. Archives of Biochemistry and Biophysics. 1984:233:2:565-572; Olle R et al. Structural relation among mouse and human immunoglobulin VH genes in the subgroup III. Nucleic Acids Research. 1983:11:22:7887-97; Proudfoot N et al. The structure of the human zeta-globin gene and a closely linked, nearly identical pseudogene. Cell. 1982:31:32:553-563. [Back]
7 Kollias 1987; Covarrubias L et al. Cellular DNA rearrangements and early developmental arrest caused by DNA insertion in transgenic mouse embryos. Molecular and Cellular Biology. 1987:7:6:2243-2247; Humphries RK et al. Transfer of human and murine globin-gene sequences into transgenic mice. American Journal of Human Genetics 1985:37:2:295-310; Khillan J et al. Tissue-specific, inducible and functional expression of the Ead MHC class II gene in transgenic mice. EMBO Journal. 1985:4:9:2225-30; Palmiter R et al. Cell lineage ablation in transgenic mice by cell-specific expression of a toxin gene. Cell. 1985:43:1:9-18. [Back]
8 Moore 1982:14; Lewin 1983:9-13, 202-203, 681; Emery 1983:93; Lejeune J in Martin Palmer ed. A Symphony of the Preborn Child: Part Two. Hagerstown, MD: NAAPC: 1989:9-10, 16-19, 30. [Back]
9 Lewin 1983:11-13, 202-203, 681; Emery 1983:93. [Back]
10 That differentiation is not caused by the mother and is determined by the embryo: Holtzer H et al. Induction-dependent and lineage-dependent models for cell-diversification are mutually exclusive. Progress in Clinical Biological Research. 1985:175:3-11; Mavilio F, Sineone A et al. Differential and stage-related expression in embryonic tissues of a new human homeobox gene. Nature. 1986:324:6098:664-668; Hart C et al 1985 [Back]
11 Szulmann AE, Surti U. The syndromes of hydatidiform mole. I. Cytogenic and morphologic correlations. American Journal of Obstetrics and Gynecology. 1978:131:665-671; Moore 1982:30; Lejeune 1989:19-19; Wimmers MSE et al. Chromosome studies on early human embryos fertilized in vitro. Human Reproduction. 1988:7:894-900; Lawler SD, Fisher RA. Genetic studies in hydatidiform mole with clinical correlations. Placenta. 1987:8:77-88; Martin GR. Teratocarcinomas and mammalian embryogenesis. Science. 1980:209:768-776; Alberts et al. Molecular Biology of the Cell. New York:Garland Publishing: 1983. [Back]
12 Moore 1982:33,62-63,111,127; Chauda K et al. An embryonic pattern of expression of a human fetal globin gene in transgenic mice. Nature. 1986:319:6055:685-689; Migliaccio G et al. Human embryonic hemopoiesis. Kinetics of progenitors and precursor underlying the yolk sac-liver transition. Journal of Clinical Investigation. 1986:78:1:51-60 [Back]
13 Moore 1982:133; Dawson K, in Peter Singer et al. Embryo Experimentation. New York: Cambridge University Press; 1990: 43-52. [Back]
14 Jones 1989:15;4;173-178. [Back]
16 Jones 1989:173-178; Engelhardt T. The Foundations of Bioethics. New York: Oxford University Press. 1985:111. [Back]