Again Moore is extremely confusing and contradictory. In fact, a thorough search of both the third and the fifth editions of Moore's text books reveal no formal definition of the term "pregnancy". Imagine a human embryology text book, replete with virtually thousands of formal definitions about the developing human and the female uterus ... Imagine a counsel to students that the term "abortion" would not apply to such an "early termination of pregnancy" - or to the termination of a fetus either, for that matter - and no definition of the term "pregnancy". Even an attempt to decipher one amid the various contexts in which the term is used is, once again, contradictory and confusing. Indeed, both fertilization and implantation (or later) are implied:
NOT MENTIONED
About 15% of all zygotes result in detectable spontaneous abortion, but this estimate is undoubtedly low because the loss of zygotes during the first week is thought to be high. The actual rate is unknown because the women do not know they are pregnant at this early stage. (p.36)
Within 24-48 hours after fertilization an immunosuppressant protein, known as the early pregnancy factor (EPF), appears in the maternal serum. EPF forms the basis of pregnancy tests during the first week of development (p.32)
At least 15% of zygotes die and blastocysts abort ... another 30% of women abort very early, unaware that they were pregnant (p.36)
It would seem here that "pregnancy" begins at fertilization. The pregnancy tests imply the detection of pregnancy during the first week. The terms "zygote" and "blastocyst" are used which also indicate 1-7 days. Note also the reference that zygotes and blastocysts "abort" during this earliest of early stages. Yet recall the abortion counseling, i.e., the term 'abortion" would not apply to such an "early" stage of pregnancy. Confusing?
NOT MENTIONED
IBID (p. 46-48)
IBID (p. 48)
Enough hCG is produced by the syncytiotrophoblast at the end of the second week to give a positive pregnancy test even though the woman is probably unaware she is pregnant. (p. 40)
Implantation of the blastocyst usually occurs in the endometrium of the uterus. If implantation occurs elsewhere, a misplaced or ectopic pregnancy results (p. 43)
Intrauterine pregnancy can be detected by highly sensitive radioimmune assays of hCG as early as the end of the second week ... The blastocyst may implant outside the uterus. These implantations are referred to as ectopic pregnancies (p. 46)
NOT MENTIONED
IBID (p. 46-48)
IBID (p. 48)
Enough hCG is produced by the syncytiotrophoblast at the end of the second week to give a positive pregnancy test even though the woman is probably unaware she is pregnant. (p. 40)
Implantation of the blastocyst usually occurs in the endometrium of the uterus. If implantation occurs elsewhere, a misplaced or ectopic pregnancy results (p. 43)
Intrauterine pregnancy can be detected by highly sensitive radioimmune assays of hCG as early as the end of the second week ... The blastocyst may implant outside the uterus. These implantations are referred to as ectopic pregnancies (p. 46)
Here pregnancy is detectable by the end of the second week. And the woman is pregnant at least by the time of implantation (5-7 days).
The administration of relatively large doses of estrogen (morning-after pills) for several days after sexual intercourse will prevent pregnancy by inhibiting implantation of the blastocyst that may develop. (p. 49)
Relatively simple and rapid tests are now available for detecting pregnancy as early as the third week. These tests depend on the presence of human chorionic gonadotropin (hCG), a hormone produced by the trophoblast and excreted in the mother's urine ... There is no absolute sign of pregnancy during the early weeks because a gravid (pregnant) uterus may be mimicked by several other conditions. (p. 53)
The administration of relatively large doses of estrogen ("morning-after pills") for 5 days, beginning 72 hours after sexual intercourse, will usually prevent pregnancy by inhibiting implantation of the blastocyst (pp. 49-50)
Relatively simple and rapid tests are now available for detecting pregnancy. Most tests depend on the presence of an early pregnancy factor (EPF) in the maternal serum ... and human chorionic gonadotropin (hCG) ... (p. 53)
Does "will prevent pregnancy by inhibiting implantation" mean that unless implantation has taken place a woman is not pregnant and that if implantation does take place then she is pregnant? The reference to a "gravid (pregnant) uterus" would seem to imply this also. This would contradict the first of these references, which clearly imply strongly that a woman is pregnant from fertilization on.
Almost all abortions during the first three weeks occur spontaneously; that is, they are not induced. The frequency of early abortions is difficult to establish because they often occur before the woman is aware she is pregnant. (p. 49)
Most abortions of embryos during the first three weeks occur spontaneously; i.e., they are not induced ... The frequency of early abortions is difficult to establish because they often occur before women are aware that they are pregnant. (p. 49)
The third edition acknowledges that "early" abortions may occur during the first three weeks, a contradiction of the fifth edition's abortion counseling about "early pregnancies". The fifth edition only refers now to abortions of embryos during the first three weeks, implying that the terms "zygote" and "blastocyst" would not be referred to the term "abortion". Yet simultaneously it uses the term "early abortions" during this 3 week period "before women are aware they are pregnant". One is still hopelessly confused as to exactly when "pregnancy" begins, how it is defined, and what it is a woman is pregnant with.
Question 2: A 25-year old woman with a history of regular menstrual cycles was five days overdue on menses. Owing to her mental condition and the undesirability of a possible pregnancy, the doctor decided to do a "menstrual extraction", or uterine evacuation. The tissue removed was examined for evidence of a pregnancy. What findings would indicate an early pregnancy? How old would the products of conception be? (p. 68)
Answer 2: The presence of embryonic and/or chorionic tissue in the endometrial remnants would be an absolute sign of pregnancy, but this tissue would be very difficult to find at such an early stage of pregnancy. By five days after the expected menses, i.e., about five weeks after the last menstrual period, the embryo would be in the third week of its development. (p. 448)
IBID (p. 68)
IBID, with the addition of: the blastocyst would be about 2 mm in diameter.(p.459)
Question 2: A 25-year old woman with a history of regular menstrual cycles was five days overdue on menses. Owing to her mental condition and the undesirability of a possible pregnancy, the doctor decided to do a "menstrual extraction", or uterine evacuation. The tissue removed was examined for evidence of a pregnancy. What findings would indicate an early pregnancy? How old would the products of conception be? (p. 68)
Answer 2: The presence of embryonic and/or chorionic tissue in the endometrial remnants would be an absolute sign of pregnancy, but this tissue would be very difficult to find at such an early stage of pregnancy. By five days after the expected menses, i.e., about five weeks after the last menstrual period, the embryo would be in the third week of its development. (p. 448)
IBID (p. 68)
IBID, with the addition of: the blastocyst would be about 2 mm in diameter.(p.459)
Here, in the third edition an absolute sign of pregnancy corresponds with a 3-week embryo which has implanted. Also, in the fifth edition, the term "blastocyst" is added. However, a blastocyst (5-7 days) predates an embryo (2, 3, or 4 weeks) and has not necessarily implanted as yet. Thus there could be no "embryonic and/or chorionic tissue" present. Besides, I thought a blastocyst was really a "pre-embryo", and therefore there would be no abortion, no abortus, no conceptus, and no pregnancy. Really confusing. But to continue:
Question 2: A woman who had been raped during her fertile period was given large doses of estrogen ... (DES twice daily for five days) to interrupt a possible pregnancy. If she happened to be pregnant, what do you think would be the mechanism of action of the DES? What do laypeople call this type of treatment? (p. 51)
Answer 2: DES appears to affect the endometrium by rendering it unsuitable for implantation, a process regulated by a delicate balance between estrogen and progesterone. The large dose of estrogen given to the patient upset this balance. Progesterone makes the endometrium grow thick and succulent so that the blastocyst may become embedded and be nourished adequately ... DES pills are referred to as "morning after pills" by laypeople. (p. 447)
Question 2: A woman who was sexually assaulted during her fertile period was given large doses of estrogen twice daily for five days to interrupt a possible pregnancy. If fertilization had occurred, what do you think would be the mechanism of action of this hormone? What do laypeople call this type of medical treatment? Is this what the media refer to as the "abortion pill"? If not explain the method of action of this pill. How early can a pregnancy be detected?(p. 50)
Answer 2: ... (DES) appears to affect the endometrium by rendering it unsuitable for implantation, a process that is regulated by a delicate balance between estrogen and progesterone. The large doses of estrogen given to the patient upset this balance. Progesterone makes the endometrium grow thick and succulent so that the blastocyst may become embedded and be nourished adequately. DES pills are referred to as "morning after pills" by laypeople. When the media refer to the "abortion pill" they are usually referring to RU486. This drug, developed in France, also interferes with implantation of the blastocyst. It blocks the production of progesterone. Its use has not been authorized in North America (at the time of this writing). A pregnancy can be detected at the end of the second week after fertilization using highly sensitive pregnancy tests. Most tests depend on the presence of an early pregnancy factor (EPF) in the maternal serum. (p. 459)
In the third edition does "interrupt a possible pregnancy" imply that unless the blastocyst implants the woman is not pregnant? Yet in the fifth edition a distinction is made between fertilization having occurred and a possible pregnancy. This edition also adds the latest information on drug use. Interestingly, the "morning after pills" are not to be properly referred to as an abortion pill (as we have already seen) - and therefore women might take them, being assured that they are not causing an abortion. Why the "morning after pills" would not be referred to as abortion pills has been made clear - i.e., abortion does not refer to an "early pregnancy" - i.e., when there is only a "pre-embryo" there. But why, then, would only RU486 be referred to as an abortion pill? The "entity" terminated is still a "pre-embryo" and the pills also act by preventing implantation. At least Moore should be consistent. And we still have no clue as to when "pregnancy" begins.
Such mind-boggling contradictions and multiple definitions of the most basic of human embryology terms in these human embryology text books by Moore render students, nurses, physicians, psychiatrists, psychologists, social workers, ministers, government officials, bioethicists, philosophers, theologians - even women seeking abortion counseling - completely and thoroughly confused.
If one is not a scientist, and if one wants to know what these most basic of human embryology terms mean and how they are defined, one would logically turn to a current human embryology text book for guidance. Consider a "blue-ribbon" governmental or private ethics panel or committee, or even the new non-government independent NABER26 (started with seed money from the American Fertility Society, whose board members include many of the scientists, physicians, bioethicists, lawyers and other professionals who are great proponents of abortion, IVF, fetal research, etc.) brought together to weigh and judge the appropriate "ethical" issues and responses to the various burgeoning issues in experimental research and "reproductive health" (NAROL's new focus and new name). Where would they turn to obtain the most reliable scientific definitions of the "entities" which are about to be experimented on for the advancement of medical knowledge, "reproductive health" concerns, the obtaining of purely scientific knowledge not possible by any other means, and the greater good of society?
One very reasonable possible scientific reference source would be Moore's text book on human embryology, especially the most recent fifth edition. And what would they find there now? They would find that until the fourth week, i.e., 28 days, there is really only a "pre-embryo" there - a "non-person" with no ethical or legal protections. Consequently, not only would "early" abortions be acceptable up to 28 days, but also unfettered experimental research would be acceptable up to 28 days. Thus, both human "pre-embryos" and human "embryos" would be ethically acceptable materials on which to experiment, with no ethical squabbles or regulatory oversights. That should give us pause enough.
But what about the possible use of human fetuses in experimental research? Moore has defined the fetal period from nine weeks to birth. Most human embryology text books do. So certainly the early developing human being would be protected from abortion and experimental research at least up to the ninth week - right? Well, Moore has not included the fetus in his definitions of abortion, abortus, or conceptus. No -Moore's text would not protect a fetus from abortion. But luckily at least the present OPRR governmental regulations do protect the fetus - right? A look at the present governmental OPRR regulations, and how they define the terms "pregnancy" and "fetus" should clarify the situation and relieve this tension.
It is interesting to note that the definition of "pregnancy" in the O.P.R.R. regulations on the use of human subjects in experimental research is: "the period of time from confirmation of implantation [5-7 days] ... until expulsion or extraction of the fetus."27 Thus, theoretically, a woman is not even "pregnant" from the time of fertilization until implantation. I suppose she would be considered "pre-pregnant" with a "pre-embryo". At the present moment, then, developing human beings up to the time of implantation are not protected from destructive experimental research, as that definition stands in the OPRR regulations. If the regulations were to incorporate Moore's new term of "pre-embryo", then it would be acceptable to use developing human beings even up to the 28-day stage. Thus it is not only acceptable to "terminate" the "early pregnancy" of a "pre-embryo". It would also be acceptable to use these "terminations" in destructive experimental research. This would also apply, of course, to the products of IVF. Clearly, this sets the stage for unregulated experimentation on IVF human embryos - with or without implantation. That is, even when it is planned to implant IVF human "embryos" (if that is what they are), if a scientist wants to experiment on them before implantation, then there are no regulations covering such experiments (although we will now have the expert ethical advise from NABER at our disposal).
But how do the OPRR regulations define "fetus"? A fetus is defined as: "the product of conception from the time of implantation... until a determination is made, following expulsion or extraction of the fetus, that it is viable."28 Does this mean that the fetal stage begins at implantation? How could such a blue-ribbon governmental panel of such experts have defined for so many years the critical term "fetus" as beginning at implantation? Were they just being "cautious"? Suppose that one of these "blue-ribbon" government or private ethics panels or committees were to consult Moore's third or fifth editions, a "fetus" would not exist until the ninth week, i.e., 63 days. Would this mean that if an "ethics panel" were to square its definitions with Moore's text book, that before nine weeks the developing human being (the "pre-fetus") could be aborted, experimented on, or harvested for tissues and organs with no regulations? Consider that in his fifth edition, Moore does not use the term "abortion", "abortus" or "conceptus" to refer to the fetus - only to the "embryo". So presumably, to terminate a "fetus" would no more be properly defined as "abortion" than was the termination of an "early pregnancy". Would "correcting" the present "outmoded" definition of "fetus" in the present federal regulations provide for an even longer period during the life of the "developing human" that it could be experimented on - i.e., up to nine weeks - without regulations?
Coincidentally, the optimum time to harvest fetal brain tissue is between eight and nine weeks - just before Moore's cut-off point of nine weeks in his definition of a "fetus". Given the new grants to several research institutions to use fetal brain tissue in research on Parkinson's disease, Alzheimer's disease, and several other neurological and brain disorders, the future looks grim for "developing human beings". What further "developing definitions" are in store for us in the future? Who else will be scientifically defined away as "pre-persons" or "non-persons" for the sake of basic and medical researchers? Might it be those very desperate adult human subjects who have Parkinson's disease, Alzheimer's disease, who are comatose, mentally ill, paraplegic, drug addicts, etc. - i.e., those human beings who do not exercise "rational attributes" or sufficient "sentience", and who are therefore not human "persons"? What an incredible scenario! Basic and medical researchers experimenting on two classes of vulnerable human beings, neither of which are human "persons" - with no regulations or ethical dilemmas! Their "personhood" has been defined away!
And nobody did anything about it.
Whether such contradictory and confusing scientific definitions of important basic terms used in human embryology occur because of ignorance, sloppiness, or design is debatable. Certainly the massive amounts of contradictory definitions presented in these texts would warrant a similar analysis of many other basic scientific and medical texts being used by professionals and students alike. It would appear to this writer that these various key definitions are being "ratcheted" in order to scientifically justify abortion, human embryo and fetal research. This is the ultimate in the on-going politicization of science. And unless the errors and inconsistencies are corrected immediately, we are not only entering a protracted period of "false concepts concerning our own development"; we are entering a protracted period of abysmal abuse of human beings in medical research - pre-born and adult. The stage has already been set.
1 Moore, Keith, L. and T.V.N. Persaud (eds.), The Developing Human (5th ed.), (Philadelphia: W. B. Saunders Company, 1993): will be compared with Moore, Keith L. (ed.), The Developing Human (3rd ed.), (Philadelphia: W. B. Saunders Company, 1982). [Back]
2 Kischer, C. Ward and Dianne N. Irving, "A new wave dialectic: The reinvention of human embryology and a futuristic philosophy for humanity", in progress. [Back]
3 For discussions on the scientific invalidity of the term "pre-embryo" see: Kischer, C. Ward, "Human development and reconsideration of ensoulment", Linacre Quarterly 60:1 (Feb. 1993), 57-63; Irving, Dianne N., Philosophical and Scientific Analysis of the Nature of the Early Human Embryo (doctoral dissertation, Washington, D.C.: Georgetown University, 1991), 134-149; Irving, "Philosophical and scientific expertise: An evaluation of the arguments on 'personhood'", Linacre Quarterly 60:1 (Feb. 1993), 18-46; Irving, "The impact of scientific 'misinformation' on other fields: Philosophy, theology, biomedical ethics, public policy", Accountability in Research 2:4 (April 1993), 243-272; LeJeune, Jerome (testimony) Davis v. Davis, Circuit Court for Blount County, State of Tennessee at Maryville, Tennessee (1989); Carberry, James J. and Douglas W. Kmiec, "How law denies science", Human Life Review 18:4 (1992), 105; Fisher, Anthony, "Individuogenesis and a recent book by Fr. Norman Ford", Anthropotes 2 (1991), 199ff. For discussions on the philosophical and theological invalidity of the term "pre-embryo" see: Irving, Fisher (above), and Ashley, Benedict, "Delayed hominization: Catholic theological perspectives", The Interaction of Catholic Bioethics and Secular Society, R.F. Smith (ed.) (Braintree, MA: The Pope John Center, 1992), 163-180; Benedict Ashley, "A critique of the theory of delayed hominization" in D.G. McCarthy and A.D. Moraczewski (eds.), An Ethical Evaluation of Fetal Experimentation: An Interdisciplinary Study (St. Louis, MO: The Pope John Center, 1976), 113-133; Grisez, Germain, "When do people begin?", Proceedings of the American Catholic Philosophical Association 63 (1990), 27-47; Howespian, A.A., "Who or what are we"?, Review of Metaphysics 45 (March 1992), 483-502; May, William E., "Zygotes, embryos, and persons", Ethics and Medics, Part I 16:10 (Oct. 1991); Regan, A., "The human conceptus and personhood", Studia Moralis 30 (1992), 97-127. [Back]
4 Warwick, R., Nomina Anatomica (6th ed.), includes Nomina Embryologica (3rd ed.), (Edinburgh: Churchill Livingstone, 1989). [Back]
5 Ethics Advisory Board, 1979, Report and Conclusions: HEW Support of Research Involving Human In Vitro Fertilization and Embryo Transfer, Washington, D.C.: United States Department of Health, Education and Welfare, p. 101. [Back]
6 Warnock, Dame Mary, Report of the Committee of Inquiry into Human Fertilization and Embryology, (London: Her Majesty's Stationary Office, 1984), 27, 63. [Back]
7 Commonwealth of Australia, Select Senate Committee on the Human Embryo Experimentation Bill, (Canberra, Australia: Official Hansard Report, Commonwealth Government Printer, 1986). [Back]
8 Parliamentary Assembly of the Council of Europe, On the Use of Human Embryos and Foetuses for Diagnostic, Therapeutic, Scientific, Industrial and Commercial Purposes, Recommendation 1046, 1986; and On the use of Human Embryos and Foetuses in Scientific Research, Recommendation 1000, 1989. [Back]
9 Ethics Committee of the American Fertility Society, "Ethical Considerations of the New Reproductive Technologies", Fertility and Sterility (Supplement 1, 1986) 46:27S. [Back]
10 Jones, Howard W., "And just what is a preembryo?", Fertility and Sterility 52:189-91; Also Jones and C. Schroder, "The process of human fertilization: Implications for moral status", Fertility and Sterility 48:2 (August 1987), 192. [Back]
11 Robertson, John A., "Extracorporeal embryos and the abortion debate", Journal of Contemporary Health Law and Policy 2:53 (1986), 53-70. [Back]
12 Grobstein, Clifford, "The early development of human embryos", Journal of Medicine and Philosophy (1985) 10:213-236; also, Science and the Unborn (New York: Basic Books, 1988), 61. [Back]
13 McCormick, Richard, S.J., "Who or what is the preembryo?", Kennedy Institute of Ethics Journal 1:1 (1991), 14. [Back]
14 McCormick, Richard, S.J., "Who or what is the pre-embryo?", Kennedy Institute of Ethics Journal (1991) 1:1. [Back]
15 Moore (1993), 5th edition, 11-12. [Addendum 6-26-04: The Nomina Embryologica Committee has since formally and strongly rejected the terms "pre-embryo" and "individualization", as noted by O'Rahilly and Muller, Human Embryology & Teratology (New York: Wiley-Liss, 2001): "... The term 'pre-embryo' is not used here for the following reasons: (1) it is ill-defined because it is said to end with the appearance of the primitive streak or to include neurulation; (2) it is inaccurate because purely embryonic cells can already be distinguished after a few days, as can also the embryonic (not pre-embryonic!) disc; (3) it is unjustified because the accepted meaning of the word embryo includes all of the first 8 weeks; (4) it is equivocal because it may convey the erroneous idea that a new human organism is formed at only some considerable time after fertilization; and (5) it was introduced in 1986 'largely for public policy reasons' (Biggers). ... Just as postnatal age begins at birth, prenatal age begins at fertilization." (p. 88).] [Back]
16 O'Rahilly, Ronan and Fabiola Muller, Human Embryology and Teratology (New York: Wiley-Liss, 1992), 55. [Back]
17 Stedman's Medical Dictionary (Baltimore: Williams and Wilkens, 1990). [Back]
18 Larsen, William J., Human Embryology (New York: Churchill Livingstone, 1993). [Back]
19 Patten, Bradley, Human Embryology (3rd ed.) (New York: McGraw-Hill, 1968), 49. [Back]
20 Kischer, C. Ward (1993), 57-63. [Back]
21 McCormick (1991), 3; Grobstein (1985), 213-236. [Back]
22 Englehardt, H.T., The Foundations of Bioethics (New York: Oxford University Press, 1985), 111; Tooley, Michael, "Abortion and Infanticide", in The Rights and Wrongs of Abortion, M. Cohen et al (ed.) (New Jersey: Princeton University Press, 1974), 59, 64. [Back]
23 Singer, Peter and Helga Kuhse, "The ethics of embryo research", Law, Medicine and Health Care 14:13-14 (1987); Kuhse and Singer, "For sometimes letting - and helping - die", Law, Medicine and Health Care 3:40 (1986), 149-153; Kuhse and Singer, Should The Baby Live? The Problem of Handicapped Infants (Oxford University Press, 1985), 138; Singer, Peter, "Taking life: abortion", in Practical Ethics (London: Cambridge University Press, 1981), 122-123. [Back]
24 Moore, Keith L., The Developing Human (Philadelphia: W.B. Saunders Company, 1982), 1; Jones, D. Gareth, "Brain birth and personal identity," Journal of Medical Ethics 15:4 (1989). [Back]
25 Richard G. Frey, The ethics of the search for benefits: Animal experimentation in medicine", in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp. 1067-1075. [Back]
26 National Advisory Board on Ethics in Reproduction, 409 12th Street, S.W., Washington, D.C. 20024-2188. [Back]
27 Code of Federal Regulations 45 CFR 46, OPRR Reports "Protection of Human Subjects", Department of Health and Human Services, National Institutes of Health, Office for Protection From Research Risks, 1983 (revised 1989, 1991), 12. [Back]