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Abortion: Is there a point at which it becomes a moral or ethical “misstep”?

QUESTION - FREE MICROSOFTIf you belong to a faith tradition or religious perspective that views the fusion of sperm and egg as marking the advent of a human life, you are probably very unlikely to modify your stance. As one who grew up in the Bible belt among Protestant fundamentalists and evangelicals (upwards of 90% of my family), I know where you are coming from. There is black & white, with grey being a species of unacceptable compromise that is akin to bedding down with evil incarnate.

If you happen to belong to the “B & W’ contingent, perhaps you buttress your antiabortion convictions like many aspects of your most cherished religious beliefs with borrowings from the world of science and medicine, however tenuous some of these may be. As you may know or at least have heard, many religious beliefs are not testable and thus lie outside the purview of science. For example, the religious concept that every human has a soul or spirit imputed by the Almighty at conception or thereafter is not something that can be tested and verified or refuted using the tools of science. There is no laboratory assay that will disclose or measure something that is held to have no material substance as we know it and which is not physically manifest in cells or tissues or such.

For believers who hold that ensoulment (i.e., spirit is imputed) occurs at conception, and (who) refuse to consider even slightly modifying this perspective in light of contrary biblical reasoning, there exists an impasse that cannot be readily breeched (If at all). When enough people embrace such a spin on what constitutes viable human life, their collective influence on the direction state and even federal legislation takes is felt (Some would argue disproportionately so). Of course, the courts have weighed in to keep even majority sentiment from what they conclude impinges on or overrides the Constitutional rights of the minority.

Many scientists regard the convictions of those who hold that viable human life begins at conception or during the very early stages of development as both presumptuous and naive. Many religionists and theologians agree. Among those who happen to hold fast to a belief that a fertilized egg is entitled to full status as a viable human, the use of blastocytes or very early stage embryos constitutes a species of murder. Some even go so far as to decry those who take exception to their faith-based beliefs as being immoral or amoral.

Does the truth lie somewhere between the strictly secular and the sacred? Most of us probably harbor a feeling that somewhere in all this – lurking in the facts of biology and the world of polemics and logic, ethics and religion – there is an answer that will win the day. If this is the case, it is quite obviously going to take time for such a truth to fully emerge.

Many have asked me, “What is your spin on what constitutes viable human life?” Being as I have a foot in both worlds – which is to say religious belief and science – it seems logical to suppose that I would be able to offer up a “faith and science-friendly” opinion as to when viable human life begins. Well, yes, I do have something to offer up for consideration though the only thing I can be 100% certain of is that my opinion will be contested by people on both sides of the “great divide”. With this in mind, here is my spin – informed by biology, of course.

The heart begins beating at three weeks of gestation and the first neural reflex is manifest at eight weeks (and consists of hand withdrawal in response to stimulation of the fetal lip region). During weeks 9-13 the first brain waves appear and are discernible using special medical instrumentation.

Given that death is defined (in part) as a cessation of both heart and brain wave activity, one could argue conversely that to be alive in any meaningful sense beyond mere biological existence (A petri dish bearing a cell culture has biological existence, after all)  begins when both heart and brain are operational – week 9 onwards.

Interestingly, in my own faith tradition which is informed by lines of moral & ethical reasoning in Rabbinic Judaism, the fetus generally becomes a viable human life after day 40 of gestation. In the ancient Jewish context, the fetus is deemed to be little more than water until “quickening” occurs, about 40 days after insemination. “What Do Orthodox Jews Think About Abortion and Why? By Judith Shulevitz – Orthodox Jews on Abortion. If we take week 9 as our bench mark — the heart and brain being recognizably functional – then the fetus would be deemed viable from about day 63 onward.

Applying this definition of when human life becomes viable, it follows that embryos from conception to week 9 or so are “pre-viable” or “proto-viable.”

Now is this to say that embryos prior to week 9 are “fair game”? Say, that we can create embryos strictly for the purposes of harvesting their tissue and/or stem cells for medical research or other applications? These embryos aren’t viable, so why not? Well this brings us full circle to religious and ethical concerns. Rather than belabor that in this op-ed piece, I would direct readers to an excellent treatment of this subject in this posted article: Jewish Virtual Library – Abortion

OK, so we don’t create embryos to harvest, how about using intentionally aborted fetuses as a source of tissues or embryonic stem cells for research or medical application? As one fellow actually said to me, “Hey, Doc, they are going to die anyway, so why not get some good out of them for sick and ailing people”. To my mind, this comes uncomfortably close to the arguments advanced by physicians and scientists who performed hideous experiments on human subjects in Nazi concentration camps. This very line of reasoning was, in fact, used as a defense by some of the physicians being tried for war crimes in the 1946 “Doctor’s Trail” in Germany). Granted, there is a world of difference between elective abortion and the intentional dispatch of life at the hands of doctors (such as the late Nazi “Angel of Death” Dr. Josef Mengele and his ilk) who abandoned universally acknowledged medical ethics in the service of the state. But even so, harvesting aborted fetuses from any source does strike many folks in America as constituting a form of callous utilitarianism that can’t help but bring to mind some of the most egregious polities and activities in the Nazi bio-state – or perhaps the fear that our country is headed in the direction of making prophecy of the classic sci-fi film “Soylent Green” – or both. And even if the intentional abortion of a fetus before week 9 were universally embraced as morally and ethically acceptable – in no way offensive to humankind or the Almighty – there remains something hauntingly “predatory” about utilizing material from intentionally terminated “pre-viable” human material.

All things considered, it seems unlikely that access to abortion will prove a genie that can be returned to the proverbial bottle (This side of the US becoming an authoritarian or police state run by pro-life factions at all levels, that is – something the majority of Americans would vehemently oppose). And while restrictions on the direction embryonic stem cell research and use takes will likely continue to be a legislative and ethical tug-of-war between various factions, a return to an outright ban on government provided/sanctioned embryonic stem cell lines seems unlikely. This leaves what is being played out now at the political level:  That is, the fact many state legislatures such as my own native state of Texas in 2013 are leaning towards placing considerable restrictions on access to abortion services. This gambit may succeed especially in states dominated by a traditionally conservative majority although I predict any such this legislation will be eventually overturned by the Supreme Court as being unconstitutional.

Perhaps my life-at-9-weeks-on criteria should be thrown into the abortion access deliberations mix. Let’s revisit it:

Given that death is defined (in part) as a cessation of both heart and brain wave activity, one could argue conversely that to be alive in any meaningful sense beyond mere biological existence (A petri dish bearing a cell culture has biological existence, after all)  begins when both heart and brain are operational – week 9 onwards

Of course, I am not actually advocating that my definition (above) be transformed into new legislation or such that is imposed on all women across the land. But for women who come out of conservative faith traditions what I have laid out might help them in deciding at what point-in-time during a fetuses’ development abortion constitutes an ethical or moral misstep. For those who find my approach reasonable, use of a “morning after” pill constitutions no sin nor does an abortion prior to week ten (10) post-conception.

In the final analysis, the whole matter comes down to personal choice informed by the unique constellation of social and life factors & players that characterize each woman’s life.

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© 2013 by Dr. Anthony Payne. All rights reserved.

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HYPOTHESIS: Two ways in which cytomegalovirus carrying male germ cells may play a role in the genesis of autism spectrum disorder

Recently a paper was published showing that 33 of every 10,000 children born to older men (40 years of age or older) have autism spectrum disorder compared to 6 of every 10,000 children born to younger men (<30 years of age). Excerpts from a report in Nature News titled “Male biological clock possibly linked to autism, other disorders will help flesh this out:

“In a study of more than 100,000 people, along with records about their parents’ ages, Avi Reichenberg at King’s College London and his colleagues found that 33 out of every 10,000 offspring of men 40 years or older had autism spectrum disorder—a 475% increase compared to offspring of men younger than 30, who fathered afflicted children at a rate of 6 per 10,000 (Arch. Gen. Psychiatry 63, 1026–1032; 2006). This association is now being tested in a larger study, says Reichenberg. A study this September showed a similar but less pronounced association of parental age with bipolar disorder (Arch. Gen. Psychiatry 65, 1034–1040; 2008).

“Spontaneous mutations can arise in both sperm and eggs. As women age, for example, they have an increased risk of delivering a child with Down’s syndrome and other disorders caused by large-scale chromosome problems in eggs, such as trisomy. But unlike eggs, sperm arise from stem cells that continuously divide—about 840 times by the time a man is 50 years old (Cytogenet. Genome Res. 111, 213–228; 2005). The theory is that the chances of mutations increase with each round of DNA replication—a process that could underlie estimates that the mutation rate in males is about five times that in females (Nature 416, 624–626; 2002).

“Any mutation you can think of occurs more frequently in the sperm of older men,” says Sebat.

For a very long time it was thought mutations associated with the passage of time was something primarily peculiar to the ovum (A woman’s unfertilized egg). The belief that the genetic material in male sperm was somehow spared age-related mutations was driven home to me by a stem cell biologist I interacted with from 2008 to 2010, who was convinced that the male body had mechanisms in place that help insure that few if any mutations wound up in mature male sperm in healthy males regardless of age. This struck me as wishful thinking and I was quick to lock horns with this chap over this. Now comes tentative evidence – again, the results of the study just announced (above) – that would appear to vindicate my position. Although it is always fun to be right, I got to wondering what other players besides normal aging might be producing mutations in at least some men’s semen that set the stage in their progeny for the development of autism and other neurological conditions. The first thing that popped to mind was pathogenic microorganisms – especially viruses.  A quick check of published research brought up one particular bit of research that seemed to signal I was on the right track:   

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143078/pdf/2042-4280-2-7.pdf“Detection of human cytomegalovirus in motile spermatozoa and spermatogenic cells in testis organotypic culture”

 The long story short with respect to this study is that it found HCMV in male germ cells from semen samples (91 fertile and 47 infertile men) and in testis tissue culture.  There was a decrease in the number of immature germs cells that is believed attributable to the HCMV.  In short, the presence of the HCMC in a man’s reproductive tract – and, mind you, 50-80 of every 100 Americans harbor the HCMV according to the CDC – tosses a monkey-wrench in the genetic apparatus of sperm resulting in infertility.  There are undoubtedly other viruses that populate the male reproductive system including others of the herpes family that may well have a similar effect.

What if the genetic changes go beyond infertility? What if HCMV produces genetic mutations in fertile men’s sperm? Some of these, I conjecture, could set the stage for producing autism in children they father.

Now – and here is where my off-the-cuff theorizing gets really interesting – what would happen if a HCMV-infected spermatozoon fertilizes a female ovum? In some instances it becomes activated and effects varying damage to one or more developing fetal tissues/organs including the brain and even generates defects severe enough to result in miscarriage. However, what I propose is that most HCMV transmitted to a fetus at conception by an infected male germ cell (sperm) is latent (inactive)and winds up in various tissues though primarily the CNS [The virus preferentially infects neurons probably brain stem & progenitor cells too (This is the case in mouse models of CMV infection)].  Though not active in the sense it produces clinical symptoms it could conceivably cause subtle neurologic changes and damage that is later manifest as autism spectrum disorder (One murine study notes: “Infection of neurons may tend to become persistent by evasion of immune reactions, anti-apoptotic effects and neuron-specific activation of the e1-promoter, presumably causing functional neuronal disorders. It has also been shown that CMV infection in developing brains may become latent in neural immature cells”. These effects were observed in active infections. However, it may affect subtle genetic damage in neurons in a child’s developing brain though the virus is latent or largely inactive).

This body of conjecture is testable. And, if it turns out HCMV is damaging some men’s germ cell DNA in ways that set the stage for autism (and possibly other neurologic disorders) in children they father and/or the virus is being passed on to zygote (by the male gamete) and ultimately the embryo’s developing CNS where it sets the stage for the development of autism or other neurologic disorders years after birth, testing for the HCMV’s presence in semen and (when determined to be present)  interfering with the HCMV in the man’s reproductive tissues by treating with extant antiviral drugs are measures that might reduce the likelihood the virus will wreck biologic havoc either in the developing embryo or later in the developing baby or child.

I hope some enterprising grad student or researcher transforms my ruminations into suitable bench experiments and runs with it.       

Additional Reading: This paper titled “Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention delves deeply into technical issues I only touched on above as well as prevention and treatment aspects of HCMV infections.

 © 2012 by Dr. Anthony G. Payne. All rights reserved. If you are a grad student or researcher who runs with one or both of the ideas articulated above, please let me know what you do and the outcome: attachi-mailbox at yahoo.com

You can access this hypothesis as a PDF document by clicking this link:  http://www.healingcare4u.org/articles/HYPOTHESIS%20-%20HCMV%20and%20autism%20-%209-9-2012.pdf

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