Sunday, April 26, 2015

Should life begin at different times depending on the legal context?

How to define when life begins is a question that has plagued societies for centuries. Some view this question in light of religious beliefs whereas others approach it from a purely scientific perspective. Regardless of how the question is framed, it is apparent that varying opinions abound.

Should life begin at different times depending on the legal context?

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How to define when life begins is a question that has plagued societies for centuries. Some view this question in light of religious beliefs whereas others approach it from a purely scientific perspective. Regardless of how the question is framed, it is apparent that varying opinions abound.

Many argue as a religious dictate that personhood begins at conception. Some scientists point out in response that many fertilized eggs never become babies. It is also difficult to determine exactly when conception occurred because sperm can survive in a woman’s body for several days, and it may take several more days for a fertilized egg to implant itself on the wall of the uterus.

In the face of religious and scientific debates, the law is called upon to respond. And its responses are not always consistent.

The question of when life begins comes up in a variety of contexts. The most visible one involves abortion and the morning after pill, most recently with regard to the Affordable Care Act’s contraceptive mandate. However, determinations of when life begins arise with regard to other issues, such as in-vitro fertilization and wrongful death lawsuits.

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When in-vitro fertilization is performed, is an unused fertilized egg a person? According to Dr. Joseph DeCook, executive director of the American Association of Pro-life Obstetricians and Gynecologists, a fertilized egg is a human life and should be adopted rather than discarded. However, others point out that homes are already difficult to find for the millions of orphans worldwide. And should we then consider it murder to throw away an embryo?

Suits for wrongful death receive relatively less public attention, but they are an important part of the debate, as illustrated by a recent case. A Colorado court considered whether twin fetuses in their seventh month of gestation who died in their mother’s womb could be considered people for purposes of a wrongful death suit against the hospital where the mother was treated. The defendant hospital in this case, St. Thomas More Hospital in Canon City, Colorado, is owned by Catholic Health Initiatives, a non-profit organization that owns over 130 health care facilities in 19 states. It argued that only babies who are “born alive” count as “people” under the law. The court agreed with the hospital, and the plaintiff has now appealed the decision to the Colorado Supreme Court.

The hospital’s argument provoked controversy, because the Ethical and Religious Directives of the Catholic Church, which govern most Catholic hospitals, states, “Catholic health care ministry witnesses to the sanctity of life ‘from the moment of conception until death.’ The Church’s defense of life encompasses the unborn.”

Catholic Health Initiatives released a statement saying, “In this case . . . as Catholic organizations, (we) are in union with the moral teachings of the Church.” However, it did not explain how the union applied.

Two things are clear. First, the law needs more consistent criteria for determining when life begins. It makes little sense that life could begin at conception in one context but not until a baby is born in another. Second, it should not be permissible to pick and choose a definition of life based on the circumstances.

Regardless of which answer is chosen, it shouldn’t vary depending on financial considerations.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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