The physician and theologian of the University of Navarra José María Pardo. PHOTO: Manuel Castells

José María Pardo, physician and professor at School of Theology at the University of Navarra, has published the book El no nacido como paciente. The volume gathers the main conclusions and proposals of his doctoral thesis , directed by Bishop Ignacio Carrasco de Paula, president of the Pontifical Academy for Life.

As the author explains, the book consists of six chapters. The first deals with some historical facts about prenatal medicine and the context in which the first ethical questions about the life of the unborn arose. The second chapter proposes the consideration of the human embryo-fetus as an individual of the human species. The third describes the diagnostic and therapeutic techniques of prenatal medicine, as well as their ethical implications.

Subsequently, the fourth chapter analyzes the use that can be made of diagnostic procedures in prenatal medicine, the fifth focuses on the physician-gestation-conceived child relationship, and the sixth deals with two sides of perinatal medicine: extremely premature births and neonatal euthanasia.

Zenit news agency interviewed the author:

-The book raises a paradox: abortions in advanced gestations and efforts to save premature babies of the same age. How do you explain this contradiction? What does this say about today's society?

It is not uncommon to hear that the most valued elements in today's Western society are efficiency and the aesthetics of appearance (the look). Within this "carpe diem" mentality, the unborn child - and even more so if it presents some anomaly - can be a "clandestine on board", an intruder who is a nuisance to be got rid of. This is why it is not surprising that the most advanced scientific-medical knowledge is used to destroy incipient life. That is why it is not surprising that a mother, even seeing the small body of her child, can decide, in the face of a disability, to close her eyes and abort. That is why it is not surprising that large amounts of money are spent on repopulating the face of the earth with animal species on the verge of extinction, and not enough is invested to save many unborn human lives conceived. In the same hospital, fetuses of 24 weeks of gestation are aborted in a conference room of deliveries, while in the Neonatal Intensive Care Unit, attempts are made to save premature babies of the same age. It is the world upside down.

-One of its objectives is to clarify who the unborn child is. Can the embryo be considered as human as any other born person?

Surprising as it may seem, one of the greatest challenges of Bioethics on the threshold of the 21st century is to seek and show the evidence, the reality. And this book wants to participate in this exciting challenge. My intention has been to go through the few centimeters of skin that cover the maternal womb. Or in other words, to try to make it transparent, to turn it into a glass womb. When one dives into this unknown world from the outside, one is surprised and amazed by the greatness of life in its first steps. The unborn does not speak like us, does not reason like us, does not weigh what we weigh, but is exactly like us: it eats, hears, dreams, feels pain, cries, plays, is susceptible to medical diagnosis and treatment, etc. At final, he is one of us.

-One of the sections talks about the suffering of the fetus. Is there evidence that the fetus can suffer from it?

Fetal pain is currently the subject of numerous scientific studies programs of study . It is a new challenge for medicine. After an extensive review in the main scientific journals that deal with this topic, it can be concluded that it is becoming more evident every day that in the second trimester of gestation (from the 24th week, and very possibly from the 16th week) the fetus reacts to stressful stimuli, which if not alleviated can cause short, medium and long term damage deadline on organic function (cerebral, cardiovascular, skeletal and visceral problems), nonicepception and neurobehavioral development . To state with certainty that pain perception is not present in the early stages of human life is to ignore important clinical and scientific evidence. Moreover, in case of reasonable doubt it is preferable to alleviate stress and pain with the employment analgesia than to expose the fetus to serious injuries in the future.

proposal -What are the ethical consequences of this viewpoint for the physician's responsibility?

Obstetrics is the art and science of caring for two patients at the same time: the unborn and the pregnant woman. What I have tried to show is that in the doctor-pregnant (spouse)-conceived child relationship, the figure of the health professional is not a neutral element, but plays a determining role. Although it is up to the parents, in the first instance written request, to make decisions for the care of the life and well-being of their children, the work and closeness of the physician is necessary. His mission statement is to help parents make mature, free and responsible choices about prenatal life.

Diagnostic and therapeutic techniques can be a double-edged sword when applied in prenatal medicine. What does it mean to make good use of them?

The difference lies between "knowing in order to cure or to improve the health conditions of the fetus or the pregnant woman" and "knowing in order to get rid of what does not meet the expectations of the parents". It is very different to have an ultrasound with the intention of aborting if the fetus presents some disease, or to have an ultrasound and continue the pregnancy until the natural death of the sick child. It is necessary to know that in many places fetuses carrying anomalies are being identified not to try to cure them, but to be able to eliminate them later on. Prenatal diagnosis is being applied as a real "police" modality Genetics ", to identify and eliminate a fetus that is guilty of being sick or of not meeting the expectations of its parents.

-Sometimes, informing parents that their child may have a malformation, disability or syndrome leads to the decision to abort. What actions can the physician take to avoid this (better communication...)?

When faced with the diagnosis of an embryo-fetal pathology, prenatal life (the embryo, the fetus), rather than a clinical case or a set of symptoms, is a patient, a fragile you, who is in a situation of need and dependence status . Hence the need to place unborn human life, and not the disease, at the center of the relationship. On many occasions, health agents will have to act as "grandparents", helping parents in the process of approaching -knowledge - that sick child who is moving away from their expectations and dreams. As I have already pointed out, medicine is able to treat many fetal diseases: hypothyroidism, anemia, fetal arrhythmias, spina bifida, vesico-ureteral reflux, diaphragmatic hernia, etc. But even when the fetus is diagnosed with a disease incompatible with life, medicine can do something. When a child wants to enter a dark room, two things can be done: either turn on the light, or take him by the hand and go in with him. Medical science brings the necessary light when the physician does everything possible to cure. When it is not possible to bring light into the darkness, you take the child by the hand and go in with him: together you are less afraid.

-What attitude should be adopted in the face of a terminal fetus?

The phrase "nothing can be done" cannot be applied. The fetus can be accompanied until the natural pre- or post-natal end, together with its parents and relatives, providing whatever it needs (analgesia, for example), without falling into therapeutic excess. The terminal fetus is an individual of the human species, one of our own, who needs to die with dignity.