Over the past months we have been grappling with ethical issues related to the right to life, first by the discussion on embryo freezing in in-vitro fertilisation procedures, and more recently by the call for the introduction of the morning-after pill.
The debate had barely begun when we were faced with another ethical issue related to life. From the right to life the discussion turned to the obligation to life, as a patient suffering from a degenerative condition faced MPs to explain his need for euthanasia.
Never before has our society had to deal at once with so many issues that are unrelated to each other in practice but could be the same bone of contention in theory. When does life start, when does it end and who decides? These are the main questions upon which these three issues are hinged.
Despite the fact that embryo freezing, the morning-after pill and euthanasia need to be discussed separately and at length, I believe that, as a society, we must, first and foremost, make a serious attempt to come to grips with pertinent questions on the commencement and termination of life.
The presence or absence of brain life defines the presence or absence of human life in the medical sense
This does not mean repeating old scaremongering arguments that are not fact-based and only serve to kill the meaningful debate before it has even started. Arguments need to be based on multifaceted scientific studies that explore the biological, psychological and social aspects surrounding such issues. Only then can we hope to arrive to a sound moral decision.
As a medical practitioner, I would like to lend my weight to this debate from a biological point of view, precisely by discussing the commencement of life. It must be said that there is still some disagreement on this issue, even scientifically.
Some believe that life starts at fertilisation, when the sperm meets the ovule. Others believe that it starts at implantation, when the fertilised egg implants itself to the uterus wall. Others still are of the opinion that human life starts at the first signs of brain activity.
I share the last opinion. My belief is that there can be no life without brain activity. In practice, this is also what our society believes and acts upon.
When a person in intensive care is brain dead, there is all-round agreement that the machines can be switched off and the organs removed in cases of donation. This has been and still is the regular practice in Malta. No one refers to this act as killing, simply because there is no life when the brain is dead.
It then follows that there cannot be life when the brain has not even started to form.
The brain-life theory is based on the fact that, as J.M. Goldenring puts it: “The brain is the only unique and irreplaceable organ in the human body, as the orchestrator of all organ systems and the seat of personality”. The presence or absence of brain life, therefore, defines the presence or absence of human life in the medical sense.
IVF cannot be compared to the MAP. Not only are the procedures completely different but the scope is also diametrically opposed: whereas the former seeks to create life, the latter seeks to prohibit it.
Yet, as far apart as the two procedures are, the ethical controversy over which stage marks the commencement of life crops up in IVF’s embryo freezing as well as in the whole MAP debate. Based on the brain-life theory, there would be no controversy over either procedure.
On the basis of the brain-life theory, I believe the IVF law should be revised to include embryo freezing, especially in the light of recent statistics showing that Malta has abysmal IVF results.
I am also in favour of the morning-after pill as this is a contraceptive measure and does not interfere with a pregnancy that has already occurred. From my experience as a family GP, I know for a fact that the MAP will not only be useful for single or unmarried women but also for those who already have children and are not in a position, financially or otherwise, to enlarge their family.
A simple way for a serious doctor prescribing the MAP and making sure it will not abort is by taking a urine test from the patient showing whether or not she had ovulation. If she has not ovulated, then giving her the morning-after pill will not be abortifacient because it will only prevent ovulation and impair sperm motility, hence, preventing pregnancy.
Etienne Grech is a Labour MP.