DR. EMMANUEL ODUWARE (MD)
Recently, I got a call from a registrar in my department. She was the resident on call that weekend at the general practice clinic; she needed my opinion on a critical issue.
A traumatized 16-year-old had presented in company of her distraught mother; she had reportedly been abducted on her way home five days prior, had escaped from the kidnappers’ den a day before presentation, and was serially raped during the period of captivity. The resident needed to know if there was a window of opportunity for intervention. I instructed that the patient be placed on the routine levonorgestrel emergency contraception, as well as the antiretroviral post-exposure prophylaxis. I then scheduled an appointment with the patient for the following Monday. Upon presentation at the clinic on the appointed day, mother in tow, a pregnancy test and a retroviral screening was conducted which turned out negative. However, clerking further revealed that her first day in the captor’s den coincided with her ovulation day deduced from the onset of her last normal menstrual period. She presented five days after the first sexual assault; having only escaped the day prior; which was technically outside the scope of efficacy of levonorgestrel. She was hitherto a virgin, and neither she nor her forlorn mother, could contemplate the possibility of her getting pregnant.
As per protocol, the next step was to schedule an appointment with the Obstetrics clinic, for an intrauterine contraceptive device to be inserted. This presented an ethical dilemma; the principal mechanism of action of the IUCD at this stage, would be to prevent implantation of the blastocyst, in the event that fertilization had occurred, and hence be functioning as an abortifacient. Sequel to my discourse with the patient and her mum, and a call put through to a Senior Registrar friend of mine, I referred her to the OBGYN clinic, for the IUCD insertion, and subsequently scheduled an appointment with the patient and her mum in our family therapy clinic, with a psych consult in view. I was however unable to shake off the nagging, subconscious feeling tugging at the innermost recess of my soul, precipitating to the fore every now and then–that somehow between the three of us doctors, all christians/CMDA Nigeria members, we had essentially subscribed to a procedure that could potentially terminate a pregnancy, albeit a conscionable decision. It represents one of the razor-edge, nail-biting ethical conundrums christian doctors are confronted with daily in their practice, and is itself at the heart of an unending, contentious debate about the propriety of terminating a pregnancy at any stage, for whatever reason.
Across the spectrum of opinions, there exists a clear polarity between the so called ‘pro-choice’ advocates, who believe it should be the choice of the pregnant woman, and the ‘pro-life’ advocates, who posit generally that abortion is immoral being a termination of human life, and should therefore be illegal. Contrary to a prevailing belief, amplified by a toxic political climate in western democracies, the crux of the dichotomy isn’t about the sanctity of human life, but as to the beginning of human life. The pro-choice movement, with a consensus in the medical community, believes that life begins at birth, and hence the fetus is the prerogative of the mother to keep or not. The pro-life advocates, on the other isle, are persuaded that life begins at conception, hence, the fetus is an autonomous entity from the mother, even though dependent on her for survival. It is to the latter, we as christian medics belong.
We know from scriptures that human life is sacrosanct; unlike other species, specifically created in the image and likeness of God. It behooves on us however, to be able to articulate this viewpoint in the public arena of reason, filled with skeptics, without necessarily invoking a divine imprimatur.
Many contend that fetal life isn’t human life, but only potential human life. Some go as far as to insinuate that the growing foetus is essentially a parasite, and can thus be ‘disposed’ of by the parturient at will. This argument about the ‘nature of life’ of the foetus can be answered within a scientific context. The way to know what kind of life a living organism possesses, is simply to conduct a DNA test. If the foetus carries the human DNA, it is incontrovertibly human life.
THE QUESTION OF ENSOULMENT AND PERSONHOOD
Another argument advanced by the abortion advocates, is that only after birth, does the foetus become a person, with the attainment of the human personality attributes we generally relate to. The argument thus is that since the foetus cannot exhibit human personal traits, it cannot be termed human life. This has far reaching ethical implications. The polemic can however be de-constructed by looking at the concept of developmental milestones. When a baby is born, it goes through several stages of neurocognitive and musculoskeletal development ranging from onset of social smile, through crawling to articulation of polysyllables, and multi- word sentences. That a child crawls on all fours, doesn’t invoke any comparison to a four-legged animal, nor does the inability to walk at 6 months of life connote a lesser human status. A child does not become more human as it grows, it simply grows in its ability to express its intrinsic humanity. That humanity is conferred at conception and carried through intrauterine and extrauterine life.
THE AFTERLIFE
Comparative anthropology shows human societies have historically been intrigued with the concept of life hereafter. This belief has influenced funeral rites, including building of mausoleums, festivals for honouring the departed etc. However, the singular greatest impact of the belief in the afterlife, is the sculpting of social mores.
The belief in eternal retribution influences the moral conduct of humans in any society. As people shirk the concept of a day of reckoning beyond the flawed human justice system, they inadvertently become more corruptible. Scripture explicitly teaches about a life beyond this ephemeral existence, and why scientific evidence may be inconclusive about numerous anecdotes of near death/extra-corporeal (out of body) experiences, we are persuaded about the continuum of life beyond the ambits of physical existence. We also know that belief in the concept of the hereafter, is the most potent antidote to material determinism.
THE IN-BETWEENS
Our understanding that human life is sacrosanct, begins at conception, and transcends physical death, is what influences our perspective on the dire impacts of concepts like euthanasia, physician-assisted death, reproductive cloning, embryonic stem cell research, eugenics (designer babies), death penalty, and a plethora of medical ethical issues. We understand that humans as progenitors facilitate the onset of human life through coitus, then conception, and eventually parturition. However, humans do not initiate or create life, they are essentially facilitators with a responsibility to nurture and protect their progeny. Nonetheless, each human being ultimately retains autonomy subject only to the sovereignty and moral prerogative of the creator. Hence, even though we realise that one human can vicariously suffer and be a propitiation for another, as seen in the example of the ultimate sacrifice Christ wrought on the cross of Calvary, that person must independently consent to that decision of sacrifice, as Christ did in the garden of Gethsemane. This renders invalid the argument of harvesting embryos for the purpose of medical research, as the embryos are human beings albeit microscopic, and cannot independently acquiesce to medical experiments ostensibly for therapeutic purposes. Since we did not initiate life, we cannot take it, even in purported benevolent acts of euthanasia or physician-assisted suicide, or in administering a lethal poison to execute a convict condemned to death.
Finally, as Christian medics, we have a sacrosanct calling not just to save lives, and improve the quality of life, but also to follow the example of Christ in being a minister and a servant, in humility, sobriety and forthrightness, to all irrespective of their identity.
Dr. Emmanuel Oduware is currently Chief Resident, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
#Vision #Ethics #Career #2018