When does a cell become a person? – 03/04/2024 – Science

In a recent court case regarding the accidental destruction of embryos at an American fertility clinic, the Alabama State Supreme Court ruled, based on state law, that all embryos are children.

But this goes against global medical and scientific consensus about when reproductive cells become human lives.

In 2023, three couples accused the Mobile Infirmary Medical Center in Alabama of manslaughter. Their embryos, remnants of an in vitro fertilization (IVF) treatment, were stored at the clinic and were accidentally destroyed, according to the decision published on February 16.

The state Supreme Court then ruled that embryos, including those kept outside the womb, are children, based on the state’s Child Manslaughter Act. The decision reverses a lower court’s dismissal of the case and allows the wrongful death lawsuit to continue moving forward.

The decision has raised questions about the definition of “person” or “child”, which could have future legal ramifications for IVF doctors and their patients. But the medical and scientific consensus states that embryos are cells capable of creating human life and not real life.

“Anyone with eyes (perhaps with the help of a microscope) can recognize that a fertilized egg in a clinic freezer is not the same as a baby,” says American Society for Reproductive Medicine spokesman Sean Tipton. “The Alabama Supreme Court may wish they were equal, but they clearly are not.”

What American experts say

Other American agencies and organizations also joined the discussion.

The American College of Obstetricians and Gynecologists released a statement on the decision, saying, “The outcome of this action will certainly affect access to fertility treatment across the country, as more and more state legislatures create policies based on ideological rather than ideological definitions. scientific knowledge of what a person is”.

The American Civil Liberties Union of Alabama also released a statement: “The Alabama Supreme Court seriously overstepped its course by classifying frozen embryos, fertilized single-cell eggs, as children. The Court crossed a fundamental boundary by attributing personhood to something created in a laboratory that exists outside the human body.”

Different definitions in other parts of the world

The determination of when people begin to exist and what should be defined as an embryo has been changing in the United States and other parts of the world, as technology advances.

A perspective article published in 2023 in the journal Cell discusses the ethics of embryonic research. Its authors from Austria, Spain, USA, Netherlands and United Kingdom propose a legal definition.

They define the embryo as “a group of human cells supported by elements that serve uterine and extraembryonic functions that, combined, have the potential to form a fetus.”

Researchers propose this definition due to new technologies, which allow the formation of embryos without fertilization — beings that may never have been embryos.

Shortly after the birth of Dolly the sheep (the first cloned mammal) in July 1996, some countries began to change their definitions.

The Netherlands, Belgium, Germany and others base their new definitions on “potentiality”.

Instead of defining the embryo as human life, these countries consider that the zygote, which is a single cell and the beginning of an embryo, “is capable of generating a human being” and not a human being in its final state.

But Spain takes a slightly different view. The country defines the embryo as “a phase of embryonic development”, a phase that begins in the uterus.

The definitions of what an embryo is are slightly different, but the Alabama Supreme Court’s ruling that a frozen embryo is a child is unprecedented.

“The Alabama decision is based on an idiosyncratic view of the embryo that is very marginal,” according to Nicolas Rivron of the Institute for Molecular Biotechnology of the Austrian Academy of Sciences in Vienna. He is the lead author of the perspective paper published by the journal Cell.

Rivron explains that biology defines the embryo as a group of cells that can potentially form a fetus.

“The legal definition of an embryo is different from the biological definition because it is not intended to describe the embryo scientifically, but rather to protect it,” he continues.

“Legal definitions should be based on information from scientific views, but they are drawn up based on considerations that vary around the world, rooted in philosophical, ethical, social or cultural beliefs.”

Where does the person appear?

In a post published in 2013 on the Public Library of Science blog (which offers free access to science and medicine publications online), geneticist Ricki Lewis outlined a timeline of embryo development and presented her own opinion on where human life might begin. .

For Lewis, “the ability to survive outside another person’s body sets a practical technological limit for when sustainable human life begins. Having a functional genome, tissue layers, dorsal cord, heartbeat… none of this matters if the organism cannot survive where human beings survive.”

Richard Paulson, director of the Department of Fertility at the University of Southern California in the United States, wrote in an editorial for the publication of the American Society for Reproductive Medicine (F&S Reports) that “the concept that says ‘life begins at conception’ does not is scientific, nor is it part of any traditional religious teaching [antigo]”.

Paulson continues: “The authors of the Bible (and other religious texts) knew nothing about eggs, sperm, or fertilization. It was only after medical science revealed the basic stages of embryonic development that, in the mid-20th century, some religious groups appropriated the idea that human life must ‘begin’ at fertilization”.

What are the current practices for destroying embryos not used in IVF?

In IVF procedures, there are often surplus or supernumerous embryos. Patients need to decide whether their embryos should be stored, donated or destroyed.

“In IVF, as in nature, only a small proportion of fertilized eggs are able to implant and grow, even when we create the ideal conditions for a successful pregnancy,” explains fertility doctor Sue Ellen Carpenter, from the Bloom Fertility clinic in Atlanta, Georgia (USA).

“For me, embryos occupy an exclusive moral space. They are potential life and, therefore, require special respect and care.”

In the case reviewed by the Alabama Supreme Court, a patient entered the cryogenic nursery in 2020 and removed the embryos in question from the freezer. When she accidentally dropped them on the floor, the embryos “freeze-burned her skin,” according to the court’s ruling.

The Alabama clinic did not intentionally destroy the three couples’ frozen embryos. But other embryos collected for IVF are routinely destroyed by clinics when they do not meet the criteria for transfer for implantation in the uterus or if patients are able to conceive and do not want more children.

A 2019 study collected data from 703 questionnaires from clinics in 65 different countries on the practice of disposing of unused embryos that patients do not plan or cannot use. The results revealed that most doctors discard embryos in a specific “trash can.”

In a 2022 article published in the journal Obstetrics & Gynecology, authors from several American universities commented on concerns raised by the US Supreme Court decision in the Dobbs x Jackson Women’s Health case. The decision reversed the Roe X Wade case, which granted the federal right to abortion in the country.

The researchers note that embryonic loss is “a routine part of nature”:

“When new abortion legislation defines a person from the moment of fertilization, it opens the door to the regulation of embryos in the IVF laboratory. Laws may be enacted that make it impossible to cryopreservate embryos, due to the potential for embryonic loss. “

The researchers question whether patients could be forced to continue further embryo transfers even if they do not wish to have any more children, or whether they would be required to pay for “perpetual” storage of the embryos.

These and other questions remain unanswered following the decision made by the Alabama Supreme Court. As a result, several fertility clinics in the state have already stopped providing IVF treatments.