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Human Dignity at the Start of Life

Project-speaker: Prof Dr Thomas Strowitzki

Participating: M Anderheiden, C R Bartram, M Bobbert, D Dölling, W Härle, T Hillenkamp, A Ho, H Kiesel, A Kruse

The assessment of stages at the beginning of human life is of fundamental importance for all societies, with a large number of practical implications. The consequences of varying assessments of human dignity at the start of life shall be illustrated with two definite examples of the research with embryonic stem cells and the late abortion of potentially viable fetus'. Particularly the question will be investigated, whether a comparison with graduated potentials at the end of life allows parallels in the assessment, or just sharpens the eyes for the respective special position of both phases of life.

A) On the question of gradation of human dignity at the start and at the end of life

Central issue is the investigation, whether there are parallels between the start and the end of life, and what consequences arise from this for the definition of human dignity. As basis of further interdisciplinary reflection the medical facts will be stated first, that is the embryonic development extracorporeal, and until the end of the first trimenon including essential neurophysiological aspects as the development of the sensitive faculty. This also has direct consequence for reproductive medicine within the scope of artificial insemination. To specific pathologies of each of the development stages (e.g. anencephaly, development of trophoblast tumors from the early totipotent embryo) comparisons with medical situations at the end of life will be worked out.

Parallel the state of the developmental psychology will be described. With it, cognitions to prenatal development are in the centre. To work out differences between start and end of life in a practicable gradation, the state of knowledge on the development at the start of life as a new approach is put opposite to the question, whether a practicable gradation at the end of life, verified by analysis of empirical collected data beyond verbal ability to communicate, will be definable. Here above all, findings of dementia research shall be considered to answer the question, whether there are "regressions“ identifiable in dementia diseases at a very late stage, that can be seen as reversal processes to the "developments“ in the prenatal development stage. Besides the fundamental objection has to be discussed that also in dementia diseases at a very late stage we have to proceed from the assumption of influences of biography on experience and behavior of the individual behavior. This would mean that a central personal aspect – that is to say the "lived life“ – continues to have an effect, from which fundamental consequences result for the question for a practicable gradation at the end of life.

The worked out valuations shall be reflected according to constitutional, criminal, and civil law criteria. Central focus is the start, grade, and end of the legal protection of life and health during the various stages in consideration of the problematic nature of normative valuations of empiric differences. It will include the German positions compared with attitudes and decisions internationally.

B) On the Problematic Nature of Stem Cell Research

The latest invasion methods into the beginnings of human life with the aim to develop approaches to therapy for so far incurable diseases by embryonic stem cell research, raise fundamental ethical and legal questions on the protection of the start of human life. It not only requires further medical-biological exploration, but also ethical, legal, and social science reflections, that constitute the main focus in this project part.

At present the extraction of embryonic stem cells from the blastocyst by accepting the dying of the embryo is the only established procedure. From legal, theological, and medical views this procedure on the one hand encounters serious objections. On the other hand most of the established embryonic stem cell lines of the National Institute of Health, USA, and UK, trace its descents from surplus embryos. The therewith-achieved results are evaluated in Germany as well. As a justification for the must of embryonic stem cell research it is recently referred to parallel research. It seems to be a typical phenomenon of medical research. It is important to investigate what the causes for parallel research are in this sensitive field (adult versus embryonic ES cells, reprogramming strategies), and what it will take shape. With it are open questions for appropriate legal regulations for the effective interactions between both approaches of research, and for the results that only allow the progress of the other course, for instance, the stem cells obtained from body cells (skin cells) by planting of four "rejuvenation genes“ that show similar pluripotent characteristics as embryonic stem cells.

Another objective target of this subproject is the improvement of the continuous transfer of information and knowledge on stem cell research, and its ethical assessment in schools and in public. So far surveys on stem cell research and on other medicine-ethical questions are often influenced in its result by the low state of knowledge of the people interviewed. For the achievement of the target modules of communication in the shape of print media, Internet communication, advanced training courses, or seminars have to be developed. It can be based on the experiences of the successful school project of the IFBK, which is financed by the Bosch-Stiftung [Bosch Foundation].

C) Late Abortion

Focus of attention against the backdrop of the currently discussed legal position is the medicine-ethical and legal assessment of the problem of induced late abortion (from the 22nd week p.c.).

The medical indications described at present shall be portrayed, and be analized under the conception of disease. The medical fundamentals to be worked out for that are the definition of viability, the assessment of indication-based symptoms, and the current capabilities of prenatal diagnostics with medical consequences be derived from it. There is the question of what kind of situations can arise for pregnant women from prenatal diagnostics. The late abortion is observed also with regard to social acceptance of existing rules in particular in groups such as churches and organizations of disabled persons.

The central ethical question with legal permission of the late abortion is the advisory item. At present there is only information about the medical operation demanded for late abortion. There is consensus, that psychosocial help for the pregnant woman may be helpful. Since the late abortion often precede genetic prenatal diagnostics, the question is about the suitable chronological placement of the advisory concepts. The advisers' required competences and their financing are points at issue. Just as whether the advice should be of one's own free will, or obligatory. The contrary aspects of legal obligation for advice versus voluntariness shall be analized under ethical aspects including the achieved experiences with advisory service according to § 219 StGB [Penal Code]. The right of self-determination of the pregnant woman, the protection of the fetus, the duties of the physician, and the influence of the social and sociopolitical general set-up will be discussed in view of various advisory models. Literary reflections of projected or performed abortions shall be considered to sharpen the eyes.
Among the late abortions the embryopathical motivated is problematic above all. Much clearer than the purely medical, the medical-social indication such as the embryopathical motivated fetocide touches human dignity and right to live of the fetus that is already capable of surviving. The legitimacy in terms of constitutional law not of accepted, but targeted killing of (handicapped) life is questionable and needs to be discussed. De lege lata shall be cleared, the above all relevant terms for the medical decision (by the handicapped live, endangered) "physical condition" of the pregnant, the granting of a "medical scope of evaluation", moreover the openly against the wording of a law established relation between degree of handicap and indication, often made a subject of discussion in practice. De lege ferenda, the position for an embryopathic indication, an abortion limit, advisory models, and medical duty to cooperate are to be discussed. Professional ethics, and legal justification have to be lead according to possibility with the background of the boundaries of social acceptance for concordance. 

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