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Medical Ethics: The Start and End of Life

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Lyn Sonnenberg

on 3 March 2018

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Transcript of Medical Ethics: The Start and End of Life

Begins on day six following fertilization and can continue until around day nine.
However, achieving implantation does not make the individual more human; rather, implantation makes the individual more likely to survive.
In the 26th edition of Stedman’s Medical Dictionary“act of conceiving, or becoming pregnant; fertilization of the oocyte (ovum) by a spermatozoon to form a viable zygote.”
In the 27th edition of Stedman’s Medical Dictionary, conception is defined as follows: “Act of conceiving; the implantation of the blastocyte in the endometrium.”
According to the redefined view, a zygote less than nine or so days old, having not yet completed implantation, would not be considered alive.
The new definition would, however, have great implications in the political, ethical, and moral arenas. Personal and governmental decision-making on such issues as embryonic stem cell research, cloning, and the so-called “morning after pill” directly depends on the validity of this definition. If preimplantation blastocysts were not really alive, they could be harvested or destroyed prior to the six-to-nine day mark because “conception” had not yet occurred.
Genetically unique individual is created at the time of fertilization, each human life begins at fertilization.
Zygote formed at fertilization is different from all others and, if it survives, will grow into a person with his or her own unique set of genes.
"Twinning": Until about day 14, there is the possibility that the zygote will split, producing twins.
No uniqueness to the zygote, no humanness or personhood, until the potential for twinning has passed. They ask, if the zygote is an individual “person” at fertilization, then what is the nature of that “personhood” if the zygote should split into two individuals?
Another objection to this view is the fact the many fertilized eggs never successfully implant. An estimated 20–50 percent of fertilizations die or are spontaneously aborted
However, occurrence of spontaneous abortions does not mean that the lost were not fully human, any more than the development of some deadly disease in a child makes the child suddenly nonhuman.
“Basics of Biology” gives five characteristics of living things; these five criteria are found in all modern elementary scientific textbooks:

1. Living things are highly organized.
2. All living things have an ability to acquire materials and energy.
3. All living things have an ability to respond to their environment.
4. All living things have an ability to reproduce.
5. All living things have an ability to adapt.

Under this view, there is no question that life begins at conception. Never can the embryo or fetus be considered part of the woman’s body. Dr. Albert Liley, the renowned physiologist known as the "Father of Fetology" has stated, "Biologically, at no stage of development can we subscribe to the view that the unborn child is a mere appendage of the mother. Genetically, the mother and baby are separate individuals from conception."
Medical Ethics: The Start and End of Life
Birth Control & IVF
Hormonal birth control: "The Pill"

1. Inhibits ovulation, which is its primary means of birth control.

2. Thickens the cervical mucus with the effect that it becomes more difficult for sperm to travel to the egg.

3. Thins and shrivels the lining of the uterus so that it is unable or less able to facilitate the implantation of the newly fertilized egg.

?Intrauterine Device (IUD): Copper and Hormonal
End of Life Decisions
Take Home Messages
1. The Christian World View Believes that Life Begins at Conception.

2. Couples facing family planning decisions often require guidance and don't often have "all the facts". Embryo Adoption is now an option in Canada.

3. Families struggle with end of life issues and require spiritual guidance. These issues mirror those of conception!
When does life begin?
The point when an individual can exist separately from the environment in which it was dependent for development as the beginning of life.
This point is also known as the point of viability. With modern medical technology, premature infants can be viable as early as 25 weeks.
We have been becoming human earlier and earlier. Here the issue is not the actual stage of development of the fetus. The limiting factor rather is the current state of medical technology.
20 years ago the age of viability of a prematurely born fetus was about 28 weeks; today it is around 24 weeks. Thus, in this view, man himself, through his advances in technology, can grant humanness where it did not previously exist!
1) In the course of sperm-egg interaction, when is a new cell formed that is distinct from either sperm or egg?
2) Is this new cell a new human organism—i.e., a new human being?

Based on universally accepted scientific criteria, a new cell, the human zygote, comes into existence at the moment of sperm-egg fusion, an event that occurs in less than a second. Upon formation, the zygote immediately initiates a complex sequence of events that establish the molecular conditions required for continued embryonic development.

The behavior of the zygote is radically unlike that of either sperm or egg separately and is characteristic of a human organism. Thus, the scientific evidence supports the conclusion that a zygote is a human organism and that the life of a new human being commences at a scientifically well defined
“moment of conception.”

This conclusion is objective, consistent with the factual evidence, and independent of any specific ethical, moral, political, or religious view of human life or of human embryos."
Dr. Lyn K. Sonnenberg, MD, MEd, MSc, FRCPC, Neurodevelopmental Pediatrician
Faculty of Medicine & Dentistry, U of A @lynsonnenberg Lyn.Sonnenberg@ualberta.ca

Life begins 12–14 days after fertilization or gastrulation, the time period after which identical twins would not occur.
No individuality and therefore no humanness is considered to exist until it is not possible for twinning to happen.
Here, the initial zygote is not human and possesses no aspect of “personhood.”
The shortcoming of the twinning argument itself. Specifically, the fact that conjoined twins are distinct persons is undeniable; their humanity is not obviated by the fact that they share body parts.
Because modern society defines death as the cessation of brain waves, then the beginning of life should be viewed as the point when this brain activity begins.
The point at which a fetus will start to show the same neurological pattern as a mature brain, is at approximately 24-27 weeks gestation.
However, at week 5 the first neurons begin to appear, at week 6 the first synapses can be recognized, and at 7.5 weeks the embryo displays its first reflexes in response to stimulus.
Thus around week 8 the embryo has a basic three-neuron circuit, the foundation of a nervous system necessary for rational thought.
Life begins only at the point when the baby is born.
Baby is human when the umbilical cord is cut, and the child survives based on the adequate functioning of its own lungs, circulatory system, etc.
Even after birth, the child is not truly independent of its mother. Without care from someone, an infant would die very shortly after birth. This supposed “independence” is very much an arbitrary concept.

For You formed my inward parts:
You covered me in my mother’s womb.
I will praise You, for I am fearfully and wonderfully made;
Marvelous are Your works,
And that my soul knows very well.
My frame was not hidden from You,
When I was made in secret,
And skillfully wrought in the lowest parts of the earth.
Your eyes saw my substance, being yet unformed.
And in Your book they all were written,
The days fashioned for me,
When as yet there were none of them.
Psalm 139:13-16
Jeremiah 1:4-5
Then the word of the Lord came to me, saying:
“Before I formed you in the womb I knew you;
Before you were born I sanctified you;
I ordained you a prophet to the nations.”
Chapter 29: When Does Life Begin?
by Tommy Mitchell, MD August 26, 2010
1. What is in-vitro fertilization (IVF)?

IVF is a clinical procedure whereby fertilization is accomplished outside a woman’s body, and involves three basic steps:
• Fertility drugs are used to stimulate the female’s egg production by the female’s ovaries
• Eggs are retrieved from the female partner and mixed with sperm from the male partner
• Fertilized eggs (embryos) are mixed with the sperm and transferred to the uterus. Depending on the number of embryos produced, some may be frozen for later use.
Men: Condoms
Women: Diaphragm, Contraceptive Sponges, Cervical Caps, and Female Condoms
Calendar/Rhythm Method (24% AFR)
Symptothermal (17% AFR)
Standard Day/Bead Method (12% AFR)
RU-486 or the morning-after pill
Very Low Dose Progesterone-only Pill
Scripture uses the same word (
) for
Elizabeth's unborn child John the Baptist (Luke 1:41, 44)
Unborn baby Jesus in Mary's womb (Luke 2:12)
Children brought to Jesus (Luke 18:15)

Simply, in the divinely inspired pages of Scripture, God reveals to us that a child in the womb and a child singing and dancing around Jesus in worship are equally human beings who bear the image of God
Brain Death
Artificial Feeding
and Hydration

Organ Donation
By the end of today's class, you will be able to:

1. Apply Biblical and Scientific principles to the "when does life begin" discussion,
2. Guide couples in family planning decisions, and
3. Provide sage counsel to families facing end of life issues.
Brain death is the irreversible absence of all brain function. There is no chance of recovery with brain death. When someone is brain dead, it means there is no oxygen or blood flow to the brain. Their brain no longer is functioning in any capacity, and never will again. Neurons are undergoing necrosis. However, it does not mean that all other organs, such as the heart, kidneys or liver, are no longer viable. And this is where the confusion arises.
Medical Ethics: The Start and End of Life
Lyn K. Sonnenberg, MD, MSc, FRCPC
Faculty of Medicine & Dentistry, U of A
@lynsonnenberg, @UofADevPeds
Maureen L. Condic, Westchester Institute White Paper:
When Does Human Life Begin? A Scientific Perspective October 2008.
Natural Birth Control Methods
AFR= Annual Failure Rate
Non-Abortive Birth Control
Potentially Abortive
Birth Control
Abortive Birth Control
Embryo Adoption
2. What is a human embryo?

An embryo is a human organism during the first 56 days of its development following fertilization, excluding any time in which its development has been suspended.
3. What are the current options available to donor families for the management of surplus embryos?

Each year thousands of surplus embryos are created by couples pursuing IVF treatments across Canada.

Currently in Canada, couples seeking to deal with these extra embryos have limited options that include:
• Indefinite storage of the embryos
• Destruction of the embryos
• Donation of the embryos for medical research
• Donation of the embryos to another couple
Full transcript