When Does Personhood Begin?

And what difference does it make?

By Bob Smietana | posted 7/01/2004 12:00AM
Christianity Today, July 1, 2004.
When Aaron Barg was three months old, a hernia left him in almost constant pain. Finding a
surgeon who could repair the hernia was easy, say his parents, Steve and Susan Barg. But
finding an anesthesiologist was almost impossible.
With a rare genetic disorder called Trisomy 1, Aaron was born with a wea!ened heart and lungs
and an undeveloped brain, and he was deaf and legally blind. "octors told the Bargs that Aaron
would most li!ely die within a year. #f he survived beyond that time frame, his life would have
little $uality%he&d never spea!, wal!, or feed himself.
For most anesthesiologists, the ris! was too high. They felt any operation could !ill Aaron.
'etting the medical community to regard Aaron as a person worth saving was a challenge. Susan
Barg remembers that doctors didn&t refer to him by name, but only (baby Barg.( Though doctors
commonly refer to even healthy babies this way, she found it symbolic of their attitude toward
Aaron.
()e has a name,( she would insist. (*lease use it.(
"uring a medical visit, Barg as!ed an anesthesiologist if he would li!e to hold Aaron. )e did so
for a full hour, and only then did he agree to assist in an operation. Since then, the
anesthesiologist has helped in several more operations for Aaron.
()e holds Aaron, and he becomes a human being,( Barg says. (+ot a statistic, not a piece of
medical research on a piece of paper%but a human being with a name who responds to touch
and cuddling and love.(
+ow 1, Aaron is a handsome boy with blond hair and a face that lights up when someone he
!nows comes by. Bend down by his wheelchair and he&ll pull your face close to his, stare deeply
into your eyes, and stro!e your face. Though he can&t spea!, his eyes and hands tell you that he
!nows you are there. And he has far e,ceeded all e,pectations%he can move his wheelchair, feed
himself, and even communicate using five hand signals.
To Be or Not To Be
Aaron&s e,perience raises hard $uestions about personhood. There is no scientific agreement
over when human life begins, much less when that life attains personhood%or moral standing,
personal stature, or a soul.
But the $uestion of personhood, with its incumbent legal and moral implications, is at the nub of
all bioethics debates. "o our capabilities ma!e us persons- #f that&s the case, then some, li!e
bioethics professor *eter Singer of *rinceton .niversity, would argue that Aaron is not a person.
#f Aaron is not regarded as a person, how much less so the /00,000 human embryos, each the
si1e of the head of a pin, stored in cylinders filled with li$uid nitrogen at more than /0 fertility
clinics in the .nited States. What status do they have-
#n a recent article on Salon.com, 2ichael West, ceo of Advanced 3ell Technology, a private
company wor!ing on stem cells, described an embryo as neither human life nor a person, (4ust
an ordinary group of cells.(
(#t&s not a developing human being,( West told Salon.com. (There are no body cells of any !ind.
5 There are not even any cells that have begun to become any body cells of any !ind.(
Few in the evangelical orbit would agree with such a statement, but a limited range of belief
about personhood does e,ist among 3hristians.
2ost evangelicals would agree that personhood begins at conception, says 6ohn 7ilner, director
of The 3enter for Bioethics and )uman "ignity. At least in theory, that is.
(#f you as!ed about personhood,( 7ilner says, (people will say, in theory, they support full
personhood at conception%few people would deny that.( #n practice, though, 7ilner says many
3hristians also would (ma!e some e,ceptions for abortion in the case of genetic deficiencies, or
for the use of stem cells. And this is from people whom you&d e,pect to hold pro8life positions.(
To ma!e that distinction, he says, is to bestow personhood at a later stage in development.
9ne complicating factor for conferring personhood at conception is that a large number of
fertili1ed eggs do not implant, says )essel Bouma ###, professor of biology at 3alvin 3ollege and
chairman of the bioethics commission of the American Scientific Affiliation. :stimates of the
number of fertili1ed eggs that fail to implant run as high as ;0 percent.
3onservative 3hristians have been reluctant to face this fact, Bouma says.
(#t&s something we&ve only become aware of in the last 0 years%the ma4ority of fertili1ed eggs
fail to develop,( he says. (#f we consider the fertili1ed egg as a person, then ta!e all of the other
causes of death and multiply them by three%that&s the number of so8called persons who are
dying before developing.(
Bouma says that personhood should be conferred during the second trimester of pregnancy.
Before that point, he says, too many things can go wrong. But most evangelicals, such as <obert
". 9rr, director of ethics at the .niversity of =ermont 3ollege of 2edicine, tie personhood closer
to conception.
Uterine Hypocrisy
At one time 9rr considered personhood to begin at implantation of the fertili1ed egg in the
uterus. But threats posed by advances in biotechnology have made him reconsider.
(# thin! it&s important to hold the line for moral standing to start at conception,( 9rr says. (#f
you move the line away from conception, it 4ust opens up the door to so many technological
advances.(
9rr first became involved in bioethics following the <oe v. Wade decision in the 1>;0s. )e
eventually gave up his medical practice in =ermont, where he&d practiced for ?0 years, and
enrolled in the .niversity of 3hicago to study bioethics.
)e has studied personhood as it relates to both the beginning and end of life. =ermont has been
targeted by the )emloc! Society as the second state @after 9regonA where a (death with dignity(
bill, which he opposes, could be introduced.
9rr and his colleague, 3. 3hristopher )oo! of the 2ayo 3linic, have written an essay in the Bale
6ournal of )ealth *olicy, Caw, and :thics entitled (Stem83ell <esearchD 2agical *romise vs. 2oral *eril.(
They argue for recogni1ing a uni$ue human individual at the earliest stages of life.
#n the abortion debate, they write, it is ironic that (many argue that it is not a human until it is
&out of the uterus,& and in the stem8cell debate many argue that it is not a human until it is &in the
uterus.& These arguments based on the individual&s location are feeble attempts to deny the basic
fact understood and accepted by scientists for many generationsD humanhood begins with the
union of ? chromosomes from the ovum with ? chromosomes from the sperm.(
2ost 3hristian ethicists that 3hristianity Today interviewed hold that personhood begins at
conception. Ci!e 7ilner, though, many of them note that the practices of evangelicals don&t
always reflect that view.
For e,ample, during the in vitro fertili1ation @#=FA process, embryos are fro1en, rated for their
$uality, discarded if they hold genetic defects, or thawed and dumped in the trash if they are no
longer needed. +one of these practices would be acceptable in the case of fully developed
persons. But most are accepted by evangelicals undergoing #=F treatments.
The scale of #=F and other assisted reproductive technologies @A<TA is also a concern. #n ?001,
the last year for which statistics are available, the 3enters for "isease 3ontrol reported there
were 10;,EF; A<T attempts @!nown as cyclesA resulting in /0,GF; babies. That total is up from
G/,;?/ cycles and ?0,GE> babies in 1>>G.
With an average cost of H1?,/00 per cycle, infertility treatment has become a billion8dollar
industry. And there&s enormous potential for growth. The Association for <eproductive
2edicine reports that only E percent of the estimated ?.1 million infertile couples have used #=F.
To capitali1e on this potential, a number of clinics have begun offering (100 percent money8bac!
guarantees( and financing for patients who sign up for A<T discount pac!ages.
3oncerned about the cost of #=F, the alarming number of e,cess embryos in fertility clinic
free1ers, and a tendency to view children as commodities, ethicists have begun calling for limits
on A<T. A .nited 2ethodist bioethics panel recommended to that church&s 'eneral Assembly in
early 2ay that couples forgo the use of #=F%or at least severely limit the number of embryos
produced.
A member of the committee, Amy Caura )all, adamantly opposes #=F. An ordained 2ethodist
minister and assistant professor of theological ethics at "u!e "ivinity School, )all anguishes in
her opposition. She has several friends who resorted to #=FI she adores their children.
She tells of a close friend who was (very much pro8life( before facing infertility. As a result of her
#=F treatment, the friend began to rethin! her positions on the beginning of life.
(#t became really clear, as we were loo!ing at the embryo under the microscope, that life must
not begin at conception,( she told )all after completing her #=F process.
)all believes that the rationalistic and impersonal practices of #=F%watching the sperm and egg
4oin under a microscope, rating and discarding lower8$uality embryos, and free1ing those left
over%undermine respect for life and the concept that life begins at conception.
(We thin! that abortion is something that bad women do 5 or something that irresponsible
teenagers do. 9n the other hand, #=F is something that good, respectable 3hristian couples do
to grow their families,( she says. (They are willing to go to great e,pense, to scrimp and to save,
for the procedures that will give them children. #s it possible that what&s going on with #=F is
very subtly evil-(
#=F undermines the value of human life and paves the way for using embryos as raw material for
biotechnology, )all argues. #n coming years, she believes, evangelicals will face a test of resolve
on the $uestion of prenatal life.
(For years, evangelical leaders have been very clear on the $uestion of life and personhood
beginning at conception,( )all says. (+ow that we have found a use for embryos, with the
possibility of healing ourselves and healing our children, we are tempted to rethin! our position
on prenatal life.( She points to an irony of the evangelical pro8life commitmentD (+ow that we
are being called to bear the sacrifice of a witness to life, we are tempted not to sacrifice.(
"espite the concerns of )all and other members of the .nited 2ethodist bioethics committee,
their recommendations about forgoing #=F%and any reference to the embryo as (a form of
human life(%were eliminated from the bioethics resolution passed at the latest 'eneral
3onference.
The 3onference passed an additional committee recommendation that e,cess embryos be used
for stem8cell research. )all co8wrote a dissent from that position.
(We must repent for our actions in creating these embryos,( she says, (and then allow them to
thaw with a sense of grief and loss. To ma!e use of them allows us to avoid the reali1ation that
something indeed has been lost.(
Confused and Dangerous
)oo!, who teaches ethics at the 2ayo 3linic, is also concerned about the practices of #=F. But he
believes those practices should be reformed, rather than halted.
9ne alternative is to limit the number of fertili1ed eggs to only the number that a couple will
implant.
Stunningly, technology also can be harnessed for a lesser8!nown alternative. 3linics can free1e
fertili1ed eggs at the pronuclear stage%before the sperm and egg "+A are fused.
(#f we cryo8preserve at that point,( )oo! says, (we don&t have as much worry about the loss of
life.(
This techni$ue further muddies the issue of when human life and personhood begin. #n any
case, )oo! says, such reforms mean 3hristian couples have to be specific about their beliefs
when tal!ing with doctors.
The medical community&s concept of personhood varies sharply from the most prevalent
3hristian views. Bob Scheidt, chair of the 3hristian 2edical Association ethics commission, says
the medical profession uses four characteristics to define personhood.
All four are related to the function of the neocorte, of the brainD rationality, self8awareness,
communicationJrelationship with others, and happiness. Scheidt believes that these functions
fall short of a true definition of personhood.
Some of them, li!e self8awareness and rationality, disappear when a person is under anesthesia,
for e,ample. "oes that ma!e a patient under anesthesia any less of a person-
Ci!e many ethicists, Scheidt is concerned that personhood is used more often than not to
e,clude, rather than include people.
(When we didn&t want to treat blac!s as e$ual,( he says, (we defined them as not persons or as
three8fifths of a person in the early American 3onstitution. We define a fetus as a non8person,
and then we can do whatever we wish with it. 2ost recently Kpersonhood hasL been used in
arguments about people in persistent vegetative states.(
Scheidt believes that the issue of ensoulment is less important than that of the image of 'od.
(We are bearers of an alien dignity,( he says. (We bear the image of 'od%we are more than
phenomena of the earth.(
'ilbert 2eilaender, professor of 3hristian ethics at =alparaiso .niversity, says we must restore
the notion that a person is something more than a set of capacities.
#nstead, he argues that all human life has value because 'od cares for it regardless of capacities.
For e,ample, he says, while a Scriptural passage li!e *salm 1>D181G @(Bou !nit me together in
my mother&s womb 5(A may not be a (proof te,t( for personhood at conception, it does show
that ('od&s care and his hand are on those who have no capacities.(
Because we are of e$ual dignity, according to 2eilaender, we are not at each other&s disposal.
Any attempt to separate personhood from human being undermines this essential human
dignity. #ronically, he says, ..S. society has limited the idea of personhood in order to narrow its
moral responsibility. (The class of human beings,( he notes, (has come to be much larger than
the class of persons.(
3hristian theology can offer a corrective to that limited view of personhood, 2eilaender
believes. By articulating the value of all human beings, he says, (We will be able to show the way
in which the language of personhood is confused and dangerous.(
Allen =erhey, who chairs the department of religion at )ope 3ollege in )olland, 2ichigan,
offers a theological perspective that agrees on the dangers of mere humanistic criteria for
personhood.
=erhey sees a parallel between the parable of the 'ood Samaritan and the debate over
personhood. The $uestions (Who is a person-( and (Who is a neighbor-( both have the same
goal%(to find out where our moral duties end,( he says.
(6esus doesn&t give a set of criteria to define who is a neighbor,( =erhey says. (#n the same way, #
don&t thin! we can give a set of criteria to define who a person is.(
Twin Approaches
At the *resident&s 3ouncil on Bioethics, William )urlbut of Stanford .niversity approaches the
issue of individual status from a biological perspective.
)e never discusses the soul, and only rarely does he bring up personhood.
#nstead, he as!sD (When does the embryo become one of us- When does it become an individual
with moral standing-(
)urlbut, who focuses on the ethics of biotechnology, argues that biology can show when an
embryo is worthy of full moral status.
(#t&s undeniable that you have biological continuity in the unfolding of a life,( he says.
(Fertili1ation initiates the most comple, chemical reaction in the !nown universe%once
initiated, you have a transformation from a 1ygote @fertili1ed eggA to an organism with an
integrated, self8directed, self8assembling tra4ectory of a life.(
:thicists often refer to the human embryo as a (potential human being.( )urlbut bal!s at this
characteri1ation, ob4ecting to potential being confused with mere possibility. <ather, he says a
human embryo has (potential as potency.(
(#t&s a living entity,( he says. (The embryo is a self8assembling individual that is on
organi1ational continuity with the later fetal stage, the baby at the breast, the teenager%all the
way to natural death, you have a continuous, unbro!en continuity of being.(
The real drive behind the argument over personhood, at least for human embryos, says )urlbut,
is that they have become a potential resource for biotechnology.
(#f there was no use for the embryo,( he argues, (people would be more willing to grant it full
moral standing from the beginning.(
Beyond conception, the ne,t scientific threshold for moral standing comes at 1/ days. That&s
when the primitive strea!, a precursor of the spinal column, appears in an embryo. Before then,
)urlbut says, embryos have been seen as (inchoate compost cells( or simply raw material for the
developing life.
But new research into mammalian embryology, he says, shows (there is already development in
the individual embryo at its earliest stages.(
Fourteen days is also when (twinning( can no longer occurI that is, until that point the embryo
could split and become identical twins. 3onse$uently, many argue that until this point the
embryo is not an individual person. But )urlbut says the potential for twinning has no bearing
on the embryo&s humanity.
(The moral standing doesn&t change with twinning,( he says. (Bou had one human life, and now
you&ve got two human lives.( Twinning occurs when the embryo (is disrupted and heals itself,(
he says. @This process happens 10 times more often in #=F labs than in ordinary development in
the womb, he says.A
This purely biological view is a !ind of twin to the theological view espoused by evangelicals
such as Susan )aac!, a Wisconsin 9B8'B+ and member of the ethics commission of the
3hristian 2edical Association. She says that, biblically, she cannot separate human life from
personhood.
Based on one part each of theology, ethics, and biology, she traces personhood bac! to those first
stages of life. After conception, she says, (you have the same being all the way to birth and
beyond.(
)er theology echoes <oman 3atholic teaching.
(From the moment of conception,( the 1>F; encyclical Donum Vitae says, (the life of every
human being is to be respected in an absolute way because man is the only creature on earth
that 'od has &wished for himself& and the spiritual soul of each man is &immediately created& by
'odI his whole being bears the image of the 3reator.(
Susan Barg learned this truth firsthand from her son Aaron. After he was born, her gynecologist
told her that he would have counseled her to have an abortion had he !nown beforehand about
Aaron&s Trisomy 1.
Barg says she would have found a way to follow her doctor&s advice and 4ustify ending Aaron&s
life. +ow she can&t imagine ma!ing that decision.
()aving Aaron here has helped me understand that 'od doesn&t ma!e mista!es,( Susan says.
(Aaron has a mission on this earth to fulfill, and a purpose%4ust li!e you and # have.(
Bob Smietana is eatures editor o The Co!enant Companion, the monthly maga"ine o the #!angeli$al Co!enant
Chur$h, and a reelan$e religion %riter based in Chi$ago.