THE PRENATAL PERSON: Ethics from Conception to Birth by Norman M. Ford
(Blackwells, 2002, 272pp, $49.95. Available in general bookshops)
The first 50 pages of this book are divided into three chapters grouped together as Part I: Foundations. The remaining 140 pages are divided into six chapters grouped together as Part II: Ethical Issues.
Readers of Part I will be reassured to find clear statements of such principles as: "The State may not take, or legalise the taking of, the life of any innocent human being" (44); and "Law-makers should not relax laws which protect innocent human life from any form of deliberate killing" (51).
The author makes it clear that life includes embryonic life (44), and that life can be ended by intentional omission no less than by positive act. Even patients who cannot be cured are entitled to basic comfort and normal nursing care, including artificial nutrition and hydration according to need (45). Papal statements in support of these principles are repeatedly cited.
But in Part II the reader encounters difficulties, beginning with the first sentence: "I will now consider when the human embryo begins" (55).
Readers familiar with Fr Ford's earlier book When did I begin? may not be surprised that he has not changed his mind since 1988; other readers may find it an odd question to ask as to when embryonic human life begins.
We don't find people asking when the wombat embryo begins, and most of those who, like Anglican Archbishop Peter Carnley, ask this question of the human species, do so with a clear practical objective: to convince us that destructive experiments on human embryos are all right.
It is important to understand that Fr Ford does not share this objective. He insists that there must be no experimental destruction of what are variously called "early embryos" and "pre-embryos" - his preferred term is "proembryos" (67); they must be treated as if they were young human beings, even though he believes that they are not, but only "potential persons" (65-68).
He cites the Pope in Evangelium Vitae laying it down that "the human creature is to be respected and treated as a person from conception", while insisting that "the Church does not formally teach that the human individual and person begin with sperm entry into the egg" (64).
It is hardly a satisfactory position to insist that an entity must be treated as if it were a human being when one believes that it is not. Fr Ford's rationale for viewing the first two weeks of development after fertilisation, not as the development of a new human individual, but as cell multiplication and differentiation to form a new human individual (67), are the familiar ones: the apparent formlessness of the early embryo, and the part played by random events, of which the most spectacular is twinning.
None of this is conclusive. The formlessness of the early embryo is only apparent: the highly intricate process going on during the first two weeks could not occur without direction which can only come from within the early embryo itself.
From a strictly biological perspective it would seem preferable to see the life of an individual as having begun when all the genetic material from both parents is present, whatever influence subsequent environmental events may have on the process.
Fr Ford has no doubt that a human individual is present at the fetal stage of development, and accordingly he rejects induced abortion as unethical. He makes no exception for fetal abnormality (136), and he rejects induction of labor at 16 weeks in case of anencephaly, as is sometimes recommended, because no child can survive delivery at 16 weeks, so that the child's death would be caused by the premature delivery, not by the anencephaly.
Fr Ford is reluctant to consider oral (or implanted) hormonal contraceptives under the heading of abortion. As he cites John Wilks (83), he must have encountered Wilks' contention that oral contraceptives sometimes fail both to prevent ovulation and to prevent sperm movement. When this occurs, fertilisation may occur, and if it does, the Pill can only be effective by means of its effect on the endometrium, making it inhospitable to the newly-conceived embryo so that it does not implant but is expelled and dies; and if that is not an early abortion, what is it?
While insisting that to terminate a pregnancy for fetal abnormality is unethical (136), and aware that amniocentesis may in some cases kill by miscarriage as many babies (128), and in other cases four times as many babies (133), as the number of Down syndrome babies that it detects - and of those detected, nearly all will then be killed also (137) - Fr Ford seeks to justify some aspects of current practice in prenatal screening.
It is true that obstetricians may need to know of some conditions in advance in order to manage the delivery or to arrange for a paediatrician to be present to treat the child post-delivery. It is also true that prenatal diagnosis may sometimes reassure parents that their child is healthy, or enable parents to prepare themselves to welcome a child with a disability.
But where there is no therapeutic benefit for the child, is it obvious that a 0.5 percent to 1 percent risk of miscarriage risk "could be deemed to be ethically acceptable" (132), however eager the parents may be for the information? Would a similar risk to a born child be ethically acceptable, in the absence of any benefit for the child?
An important omission, in the section on infertility and artificial reproductive technology, is any mention of the natural treatment of infertility, in which significant advances have been made in recent years, initially in the US.
Despite its affirmation of sound basic principles, The Prenatal Person is marred by serious shortcomings and omissions. Coming from the Caroline Chisholm Centre for Health Ethics, it is likely to be influential, at least in Australia, in further entrenching attitudes and practices that are unacceptable, but have become accepted. It will do little to bring the Catholic health care system closer to the prophetic, inspiring and challenging role that it could play, and should play, in Australian medical practice.
Dr Ted Watt is a retired academic from the Department of Politics, University of Western Australia.