Abortion SIR,-Dr Joyce Poole (May 30, p 1340) is slightly confused in her assertions of the views of the Catholic Church on the status of the human embryo. What the Church has repeatedly said is that from the beginning of the fertilisation process the embryo is new human life, and this fact alone should govern its status, dignity, and rights under the law. Justice requires that an equality of respect be given to all human life and not merely because of its characteristics, attributes, or achievements. Poole feels that to describe the embryo as a person is incorrect because it has not had time to develop at least some of the properties of personhood. The Lockean understanding of personhood1 is that of manifest self consciousness and rationality, abilities that develop gradually and continuously by virtue of the potential capabilities of human embryo from conception onwards. But the Church believes it is wrong not to respect human life before it has attained these further properties. If this moral principle of respect for human life is reduced to the level of a subjective preference it would erode the foundations of British and other systems of justice. The Catholic Church has never pronounced that ensoulment occurs at conception. How could it possibly attain to such certitude? The links between contraception and abortion centre on the fact that many of the methods used in contraceptive techniques are abortifacient and that when failures occur abortion is used to take up the slack from inadequate contraception. When the contraceptive pill is used regularly and correctly failure rates of 05-2-0 pregnancies per 100 women years are reported. Used in the big world, however, away from controlled trials with medical supervision, different figures are cited-ie, failures of 2-16% in the USA and over 20% in developing countries. In developing countries, women who stop the pill within a year have an average conception rate of 55%.2 Population growth cannot solely be regulated by widespread use of contraceptive techniques. The late Christopher Tietze of the Population Council in America stated that "barring a major breakthrough in contraceptive technology or major modifications in human sexual behaviour, levels of fertility required for population stabilisation cannot be easily obtained without induced abortion". Louis Newman of the USA Department of Public Health and a former President of the American Gynecologist’s Association has said that "No country can reduce its population growth significantly without resorting to abortion". The disastrous consequences of arbitrary government interference in India and China are widely known. Poole in her great sympathy for the women of Brazil, which we all share, must surely appreciate that profound cultural factors operate in many of the developing countries that are opposed to contraception. They can only be eliminated by education, which in turn is dependent on economic growth. This is the basis of the pleading by the Catholic Church for a greater balance between the economies of the developed and the developing countries. At the same time the Church recognises the need for efficient natural family planning and has directly sponsored clinics and services to this end in 84 countries. Natural family planning depends on acceptance by the family that birth limitation is necessary. Guild of Catholic Doctors,
Brampton House, Hospital of St John and St Elizabeth,
London NW89NH. UK
Editor, Catholic Medical Quarterly
J. Identity and diversity: essay concerning human understanding (1694). Reprinted in: Perry J, ed. Los Angeles. University of California Press, 1975: 33-52. 2. Moreno L, Goldman M. Contraceptive failure rates in developing countries. Int Fam Planning Perspec 1991; 17: 44-49.
SiR,—Iwould comment on some of Dr Ryder and Mr Justice’s points (June 20, p 1544) about my report (May 30, p 1340). I am aware that the Church condones so-called natural family planning, though only since 1950; before this, "periodic abstinence" was firmly condemned as frustrating the basic procreative purpose of marriage. Unfortunately, the method has been found to be of very limited use in most developing countries. Father Sean McDonagh, writing from his wide experience as a missionary in the Philippines, reports that "not a single family, even those with daily contact with a
clinic sister, was able effectively to apply the method". Nor was he able to find evidence that any country had been able to reduce its population without using artificial methodsIt is well known, of course, that family limitation has been imposed in China just as it was prohibited in Romania, with equally disastrous results, but this is an indictment of totalitarian regimens not contraceptive clinics. With respect to the term unborn child, I suggest that Dr Ryder might look again at Gray’s Anatomy, in which he will find that the term embryo is not used until the structure that is to become the fetus is formed at about the 14th day: "Only the cells where the two vesicles (the amnio-embryonic and the yolk sac) are in contact with each other contribute to the formation of the actual embryo". Development from the time of fertilisation until this point is referred to as the pre-embryonic period for the good reason that until the embryonic area or shield has formed there is in fact no embryo-far less an unborn child. The term pre-embryo, preferred by Warnock for the first 14 days, rests on firm biological ground. Although the Church does not claim that a person is present from fertilisation, it takes the morally safe course followed by Mr Justice, that the conceptus should be regarded as having human status from the moment of conception. Fertilisation is, however, a process, not a moment, and the only incident that could possibly be regarded as momentary is the penetration of the zona pellucida by a single spermatazoon; the subsequent extrusion of the polar body of the ovum and the merging of the pronuclei of the maternal and paternal gametes can take up to 72 h. Until then the fertilised ovum has not yet acquired the human genome and there is evidence that the process of chromosomal pairing may frequently go wrong. Unsuccessful pairing results in a conceptus that is incapable of developing into a human being; a defective maternal pronucleus, for example, may lead to the formation of a hydatidiform mole which, though it results from fertilisation, can in no way be regarded as human tissue. It is thus not selfevident that the cleaving embryo has, or should be deemed to have, a moral status equivalent to that of the human person2 yet it is on this uncertain premise that the Church bases its condemnation of abortion at however early a stage, as well as a whole range of widely used contraceptive methods. The embryo is a dynamic structure of human cells with a wide potential, but at its earliest stages it cannot properly be said to be the individual human being into which it may come to grow any more than the clay on the potter’s wheel is already a particular pot.3 Ednam East Mill,
Roxboroughshire TD5 7QB, UK
1. McDonagh S. The greening of the church. New York: Geoffrey Chapman, 1990. 2. Dunstan GR. The status of the embryo: perspectives from moral tradition. London: King Edward’s Hospital Fund for London, 1988. 3. Coughlan M. The Vatican, the law and the human embryo. Basingstoke: Macmillan, 1990.
Calcitonin treatment of osteoporosis in Italy SIR,-As President and past President of the Italian Society of Osteoporosis and as researchers for several years in the study of metabolic bone diseases, we would comment on Dr Magrini and colleagues’ report (Feb 22, p 499). We agree with the financial concern that the widespread use of calcitonin in Italy could cause an excessive rise in public health costs because of occasional misprescribing of the drug by physicians. However, Magrini and colleagues’ doubts about some properties of the drug and their statement that there is no evidence that calcitonin is beneficial in elderly patients are unjustified. Calcitonin has a potent inhibitory effect on bone resorption, binding to specific receptors on osteoclasts. It is effective when given parenterally or by the nasal routed Apart from oestrogens, calcitonin is the only pharmaceutical compound approved by the Food and Drug Administration for the treatment of established osteoporosis in the USA. Magrini’s observation that calcitonin prescriptions in Italy exceed those in other European countries is not surprising since the clinical trials on calcitonin conducted in this country were among the first to contribute important scientific evidence on the effects and efficacy of the product.2 Furthermore, it has not been proven