Declaration in defence of prenatal human life
Creation: Central Commission of Deontology of the Spanish Medical Association.
sourceSpanish: Comisión Central de Deontología de la Organización Médica Colegial Española.
language Original: Spanish.
Approval: General Assembly of 19-II-1983.
Publication: Informativo Médico, February 1983 and Revista OMC, June 1991.
Copyright: No.
Checked on 14 May 2002.
Declaration of the Central Commission of Deontology of the WTO
In defense of human life in its prenatal stage
I. General Aspects
1. The sending to Parliament by the Government of a project bill on the reform of the penal code, which contemplates a radical modification of the current legal norms on abortion, causes serious concern to this committee General, the body of democratic representation of Spanish physicians, and guarantor before society of the deontological principles of the medical profession.
This document has been prepared after deep reflection, aware of the serious repercussions that this law project may have on our society, and represents a clear response from the scientific point of view to the so-called problem of decriminalization of abortion. This corporation feels the need to make its position public, both for confirmation of the deontological criteria before the health class and for the general knowledge of public opinion. The serious social responsibility of scientists in public information1 2becomes even more evident on the occasion of laws or social changes that may, due to their health content, have unfavorable consequences for society or destroy legitimate ethical reservations, which are the heritage of humanity.
On the other hand, this declaration provides the legislator with the highest level of scientific information on the conflictive problem of abortion, which allows him/her to comply with the recommendations of the recent lecture of European Ministers responsible for Public Health (Madrid, 1981), whose final text, subscribed by the Spanish Government, specifically determines that any policy on public health "must be based on a scientific basis "3.
2. This committee General also wishes to make clear to public opinion its profound respect for the Spanish Constitution, the articles of which clearly sanction the right to life of all Spaniards (Art. 15) and, in parallel, its identification with the other postulates that make human life inviolable (Art. cit.). It also wishes to make public its respect for the contents and spirit of the Universal Declaration of Human Rights (Recital III), and for the Declaration of the Rights of the Child (Resolution 1.386-CXIV)4. Both declarations must inform the interpretation of all fundamental rights recognized by the Constitution (Art. 10.2, Const.). On the other hand, this committee General expresses its identification with the realistic content of the recent resolution of the Assembly of the committee of Europe5 based on incontrovertible scientific facts, which expressly recognizes "the right to life from the moment of conception". This committee General fully subscribes to the conclusions on "the ethical and medical aspects of abortion", made public in recent years by the Royal Academy of Spanish Medicine (1972 and 1982); and can only assume the millenary ethical contents of the Hippocratic Oath, a text that reminds us how already in those distant times, and in a world with a poor appreciation of human rights, physicians already assumed the commitment to respect life6.
3. This committee General wishes to make clear to the public its concern for the bias that discussion is currently acquiring in some media, anchored on instructions unscientific or simply wrong. A dangerous demagogy distorts the biological reality of abortion before the Spanish people, leading them into error. It is especially interesting to denounce as the most serious manipulation the irresponsible attitude of those who magnify the annual number of abortions to unbelievable extremes. In reality, there is no serious statistical basis for establishing the exact number of induced abortions that take place in Spain, issue . Figures extrapolated from partial estimates of past years -when laws made the use of contraceptive methods difficult- have no scientifically valid statistical value today. The contact with this problem that health professionals have allows us to consider that the real issue of induced abortions is at least ten times lower than the most usual numerical estimates.
On the other hand, this committee regrets to have to denounce the semantic corruption that pretends to present to the public opinion the idea of abortion as a simple technical act, and that softens, before the society, the cruel execution internship that abortion supposes. Abortion is not a simple technical problem. It concerns the whole of society, and in this sense a broad and democratic discussion is required, incorporating the most prominent representatives of civil society, for a study manager and calm of the alternatives that sincerely wish to provide legitimate solutions to such a serious problem.
4. This committee General, as representative of Spanish physicians, wishes to make clear to public opinion its clear knowledge of the reality of abortion, both in Spain and in other parts of the world, and its understanding of the peculiar circumstances, sometimes very difficult, that surround pregnant women, and that make them think of getting rid of their children. It is also aware of the social pressures they suffer, but it can never admit that the formula of abortion that is advocated constitutes the legitimate solution, neither socially nor scientifically, to such problems. On the other hand, and as will be developed below, all the scientific information contained in this document supports and rationally substantiates the sense of unease that is revealed in the Spanish healthcare class , which is irremediably confronted by a legal modification, carried out without its consent, against its most basic deontological principles, not only individually but also corporately. In consideration of the social obligations of a profession of impeccable performance, and for what it represents a tyrannical violation of the ethical principles of our professional practice, this committee General is obliged to strongly reject any modification of the current legislation carried out behind the backs of the institutions representing the medical profession. And it emphasizes to the public opinion that a law of this nature, approved outside the health world (doctors, nurses, pharmacists), could constitute a permanent source of serious conflicts for the Spanish society. This is why this General committee reiterates once again before the political representatives of health and the State Government its loyal desire to partnership in the technical study of the problem of unwanted conception, which allows a deepening in the knowledge of its causes and origins, with a view to a rational reduction and a suppression of the social pressure that causes abortion and, obviously, to the consideration and implementation of alternatives that, in any case, respect human life.
II. Informing the public about various scientific aspects related to abortion topic
1. The beginning of human life, from the scientific point of view, occurs at the very instant of fertilization. This criterion is accepted by scientists and medical researchers worldwide7 . That is to say, exactly at the instant when the sperm penetrates the ovum and the ovum acquires a complete charge Genetics , which configures it from that moment on as an individual of the human species, from then on and during the whole process of development, fetal growth and maturation, at birth and until the end of its mortal life, there will be an absolute biological continuity. It will always be the same individual of the human species, only in different biological phases.
From the very appearance of the zygote, this new being born to life is a potentially complete individual of the human species, since its endowment Genetics contains each and every one of the hereditary somatic and psychic peculiarities that it will develop. After fertilization and cell multiplication, and by means of a dynamic process self-directed with admirable precision, the new human being will proceed to develop as an individual of the human species. This process runs continuously, without fissures in time, but harmoniously throughout its permanence in the mother's womb and until post-adolescence in the physical aspect. Day by day, month by month, the embryo or fetus will undergo a process of maturation of the different organic systems8 (brain, muscles, heart, respiratory system, etc.) with their specific rhythms, according to the needs at each moment of the fetal development , without at any time, from one phase of the development to the next, there being the slightest discontinuity that would allow for the time of pregnancy substantial modifications on which to base legal references.
That is to say, all those activities and functions contained in their potentiality in the genetic code of the fertilized ovum mature and emerge somatically at different moments of fetal maturation. It can truly be said that at no time is the fetus a passive occupant of the uterus. On the contrary, it soon develops various nervous and muscular activities with the support of the circulatory, metabolic, endocrine and nervous systems, and participates in the maintenance of its environment. And so on until, at the end of its fetal maturity, it effectively contributes to its expulsion to the extrauterine environment.
It is also important to clarify that the concept of human life to which we have been referring includes in its meaning those embryos or fetuses with imperfect biological features, generated from the moment of fertilization itself or at some point of fetal growth (chromosomopathies, congenital malformations or potential somatic anomalies of any kind), presumed or not through the appropriate clinical programs of study .
It is this scientific knowledge , perfectly documented by science, which makes us doctors unanimously affirm that the beginning of human life is situated at the very moment of fertilization and that, therefore, any abortive act, even one performed at the beginning of fetal life, constitutes a very serious attack on human life.
2. During the process of intrauterine growth, the fetus depends on the mother in terms of nutritional function and from the physical perspective, since it inhabits the uterus. However, at no time does it constitute a part of its mother's body. It is a totally distinct human being from every point of view. There is no doubt that the embryo is biologically a distinct individual from the mother, in whose womb it dwells, is nourished and grows. The argument that the mother is the owner of her body and does with it what she wants is radically false: she lacks any authority and any scientific argument to destroy the life of the human being she harbors in her womb. When she voluntarily accepts abortion, she destroys a human life, an individual of the human species distinct from herself, even if at this stage it depends on her.
3. Medical progress has practically eliminated the old indications for so-called "therapeutic abortion". As recently emphasized by a significant publication9 , after the introduction of modern contraceptive techniques "the number of therapeutic abortions for strictly medical reasons is negligible". In fact, progress in diagnostic and therapeutic means, contraception and a better knowledge of natural methods of birth control have extraordinarily reduced the cases of pregnancy in women affected by a serious illness, unfavorably influenced by pregnancy. Even so, in these very rare cases, the deleterious risk of pregnancy on the mother's life is rarely fatal. Therefore, in the light of the progress of medicine, it is clear that it is not appropriate to consider, as an exception, for legal purposes, the so-called "therapeutic abortion", a term that is conceptually inadmissible.
It is a different matter if, in order to cure a serious illness of the mother, a medical treatment is necessary that may have as a side effect - not directly provoked, but inevitable - the death of the fetus. A correct application of medical ethics - as is already being done now - is sufficient to make a decision in these cases, provided that it is not possible to wait until the child is born or to use another effective resource .
4. Having established these preliminary considerations, this committee General rejects outright the tacit broadening of the concept of therapeutic abortion that the project decriminalization sent by the Government to Parliament implies. In the previous case, the only debatable argument for abortion was the extremely serious condition of the pregnant mother as a result of the pregnancy.
The current law project establishes the figure of therapeutic abortion from a different perspective. Indeed, it is a dangerous misunderstanding to include in the legal text, as a reason for therapeutic abortion, the term health of the mother. This is because the concept of health is extremely broad and obviously includes the variants of physical and psychological health. This opens up a clear possibility of fraud to the law, given the ambiguous definition of the concept of health and, above all, of psychic or mental health, as applied to the pregnant woman. It is easy to foresee the perversion of the determining principle of the concept of therapeutic abortion for strictly medical reasons and the great ease with which a law thus enunciated could be manipulated, serving as a pretext for those who wish to have an abortion without any medical basis. In practice, it would be left to the woman's free will to decide whether or not to terminate the pregnancy.
5. Regarding the justification of induced abortion when the pregnancy is the result of rape, this committee wishes to state that such a circumstance is extremely rare and difficult to establish for legal purposes. Despite considering the serious attack on the dignity of women that such a repugnant act entails, it is not appropriate to consider the death of an innocent human being already conceived as a legitimate solution, just as the Constitution does not allow the rapist to be sentenced to death. The financial aid that the woman needs to recover from the deep trauma of rape excludes adding to the already irremediable the new trauma of abortion. The support that the physician can provide in these cases will not be that of becoming the main actor in the execution of the second injustice. From the medical point of view, it is necessary to articulate the appropriate information and emergency measures in hospitals to make fertilization impossible.
6. With regard to abortion for eugenic reasons, it should be noted that the fetus continues to be a human life, even if it suffers from some somatic or psychic anomaly. In spite of these deficiencies, the only thing worthwhile for it is to live. On the other hand, despite the advances in medicine, it is not possible to determine with complete accuracy the final intensity of an anomaly detected in the fetus, which could lead to the elimination of healthy human beings or those perfectly adaptable to life in society. Nor would eugenic abortion be a way to eradicate subnormality. Medicine is not in a position to detect all cases of congenital defects and, on the other hand, mental retardation of prenatal origin is only a part of the total number of cases. In final, what constitutes an index of social progress is not the capacity to eliminate the handicapped, but the improvement in the way of welcoming and caring for them.
III. Repercussions of an eventual decriminalization of abortion in the Spanish health class
1. This committee wishes to state for the record that induced abortion is not a medical act. An act is not a medical act because it uses a technique, a substance or an instrument used in medicine, nor because it is carried out in a hospital environment by health professionals. For a medical act to exist, these interventions must be aimed at saving a life or improving its health, preventing an illness or rehabilitating a sick person, contrary to what is intended by induced abortion.
2. Given that induced abortion is not a medical act, its eventual legalization would place its execution on healthcare professionals. Although the conscience clause can be invoked, many medical specialists could be indirectly involved against their will, and at some point the demanding responsibility of issuing a scientific expert opinion in cases of possible abortion would fall on them. report . Foreign experience sample shows that the pressures on physicians make the conscience clause increasingly inoperative. This reality increases the responsibility of this General committee , and obliges its members to publish this statement for knowledge and alert Spanish health professionals in general and physicians in particular.
3. This committee declares the firm will of Spanish physicians to contribute with their knowledge and dedication to everything that involves an improvement in the care of the mother and child during gestation (medical control during pregnancy, special attention to pregnancies at risk, prevention of subnormality...). When the status requires it, the response of medicine must always be to try to cure the mother's disease, not to eliminate the child already conceived, who for the physician deserves as much therapeutic attention as his mother.
4. Physicians, through their General committee , strongly reject the content of the project law on Decriminalization of Abortion included in the reform of the penal code, not only because it would turn them into real executors of an unjust law, but also because induced abortion has always constituted a serious violation of basic deontological principles.
Bibliographical references and notes:
(1) Scientists Responsibility for Public Information. (publishing house). Science. 4.507.
(2) The Social Responsibility of Scientists. Ann New York Acad Sci 1972;186:195-291.
(3) "Une telle politique devra être basée sur une approche scientifique en particulier en ce qui concerne la planification des services et des Programs...". Council of Europe. Texte final de la Conférence des Ministres Européens responsables de la Santé Publique (Madrid, 1981).
(4) Especially in this regard, by Recital III of the Preamble: "Whereas the child, by reason of his physical and intellectual immaturity, needs special protection and special care, in particular appropriate legal protection, before as well as after birth". (Text of the Resolution of 20 November 1959: Declaration of the Rights of the Child, Recital III of the Preamble).
(5) "The right to life is the fundamental right that precedes and conditions all other rights and must be protected without any limit or discrimination" (Assembly of the committee of Europe, Resolution 4.376, October 6, 1979).
(6) "And I will not give any lethal drug to anyone, even if they ask me for it. nor will I suggest such a use, and likewise, neither will I give to any woman an abortifacient pessary, but, throughout my life, I will exercise my art with purity and sanctity" (Hippocratic Oath).
(7) Senate Commences Hearings on Human Life. Congressional antiabortionists are pushing for law giving constitutional protection to embryos. Science, 1981; 121.
(8) Maturation of fetal organ systems. report from a WHO Scientific group . Geneva, World Health Organization. 1974. Technical Report Series, No. 540.
(9) "Human Reproduction". Family Planning. Vol. 3. Published by the International Federation of Gynecology and Obstetrics, London, by the committee of Population of New York and the John Hopkins Program for International Education in Gynecology and Obstetrics, Baltimore, 1980.