A Doctor on Transvaginal Ultrasounds

From here.

I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.
In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.
After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.
Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

And then there’s a call for non-compliance.

Thanks, A!

29 thoughts on “A Doctor on Transvaginal Ultrasounds

  1. I’ve shared this on Facebook and Twitter. It’s wonderful to hear a doctor calling for non-compliance and I hope the call will be widely taken up and supported by the profession and by the general public. Thank you! :-)

  2. tools of HEALING, for the sake of all that is good and holy

    Um, I know I will lose all feminist credit forever for saying this but… This is about abortion. No one is healed in an abortion. On some views, persons are killed by successful procedures.

    Just throwing that out there.

  3. The claim that abortion is not a healing procedure (which may be a true generic, although it surely is at least sometimes a healing procedure, when carrying on with the pregnancy is a health risk to the mother) is compatible with the claim that the doctor makes: that the particular instruments to be used in this procedure (which is not an abortion, of course) are tools of healing. So I’m not sure what your point is, Anonymous Coward.

  4. Medical instruments generally can be used to harm. The obvious example is a scalpel. It’s proximate effect is always to harm. It can be used to torture people (i.e., inflict pain or damage toward a non-medical end against the will of the patient).

    And that’s the point here. The ultrasound wand is being used against the will of the patient for a non-medical end (i.e., to *change her mind* about a choice she’s made). Thus, it’s not being used “for healing” (or any reasonable medical end), but for coercion.

    Also, since the risks of (esp. early) abortions to the life and health of the women are lower than the risks of pregnancy, the default is that abortion improves the health of the women. Obviously, it doesn’t improve the health of the fetus, but it’s not like it’s zero-health-beneficial in the typical case for the woman.

  5. The interesting ethical problem for health care workers is whether to comply or defy. Defiance feels so right, but is likely to result in less access to care at least in the long run. I don’t know why the professional institutions (e.g., the AMA) aren’t leading the charge, other than that they suck.

  6. Bijan, why is defiance likely to lead to less access in the long run? How do you see this as playing itself out?

    Thanks for posting this, Jender. Lovely piece.

  7. Hi Rebecca,

    If a clinic or a doctor engages in civil disobedience on this point, it’s highly likely that they’ll be shut down and lose their license. Even if you tried to be more clever about faking it, it seems highly likely that you’ll be caught out (sting scenarios are easy to imagine). If the state manages to shut down their only abortion clinic, that significantly curtails access.

    It might work out if the disobedience is massive and coordinated and at the profession level. But the level of private and public harassment has served to reduce the number of doctors willing to do abortions and the number willing to stand up about it.

  8. Good question about the AMA. They should certainly be speaking up now.

  9. For a concrete case, consider this story (seems down, here’s some extensive quotation; not sure if FP has already blogged this article):

    “I’m so sorry that I have to do this,” the doctor told us, “but if I don’t, I can lose my license.” Before he could even start to describe our baby, I began to sob until I could barely breathe. Somewhere, a nurse cranked up the volume on a radio, allowing the inane pronouncements of a DJ to dull the doctor’s voice. Still, despite the noise, I heard him. His unwelcome words echoed off sterile walls while I, trapped on a bed, my feet in stirrups, twisted away from his voice.

    So, you’re the doctor, what do you do? Even assuming you were willing, from a personal perspective, to risk your license…what happens if you do? Who’s going to step up? Do you start performing unlicensed abortions (i.e., back alley!)? What happens when you get thrown in jail?

    These sorts of issues aren’t too new for health carers, cf euthanasia. But I do think they are genuine.

  10. I agree with Bijan that lawbreaking would be likely to lead, at least in the short to medium term, to fewer doctors performing abortions. Some licenses, hospital privileges, etc. would be pulled, doctors might have difficulty obtaining professional liabiity insurance, and so forth. The overall costs and risks (to physicians who broke the law) of performing abortions would go up. And it occurs to me that malpractice insurance might possibly not cover abortions performed in defiance of the law, so a physician’s defiance could conceivably impose high risks on patients as well.

    The AMA and some other physicians’ professional associations (or at least certain of their leaders) *have* take a public stand against ultrasound laws. Some physicians’ professional associations (or at least certain of their leaders) and individual physicians have come out in support of such laws. Doctors are generally well-represented in public discourse and constitute a powerful if non-monolithic lobby through representation by bodies such as the AMA (I use the term “representation” loosely, since AMA membership constitutes only a small and dwindling proportion of the nation’s physicians, and its leadership’s views are not necessarily representative of that membership). So I did raise an eyebrow at the “deliciously silent scapegoat” bit.

    This doctor’s argument (or the suggestion of one) that the fact that physicians’ ability to perform non-medically-indicated abortions is, or at least might be in some circumstances, conditioned on a transvaginal ultrasound would meant that the informed consent was defective, strikes me as a highly questionable one under the US law of informed consent – this, even though US law sets a higher threshold for informed consent than many countries. I expect we’ll see that argument further hashed out in courts.

    While it’s interesting to get this physician’s endorsement of the “transvaginal ultrasound=rape” notion, based on anecdotal evidence (including one case in my personal acquaintance) it’s potentially very upsetting to some rape victims.

  11. Anonymous Coward… do you know how many women each year commit suicide after a baby is taken from them when, for whatever reason, in the judgement of social services they cannot look after their newborn? I know it’s ‘a lot’ but no-one knows the exact figure because the authorities don’t bother to count or even keep records. They don’t care enough to do that.

    A woman who has her baby removed from her reacts exactly like a torture victim, including damage done to their thyroid gland that results in a lifelong medical condition causing excessive fatigue, depression, an increase in cellulite which affects organ functions (including the heart), weight gain, skin and hair defects… look up hypothyroidism. Untreated it can be real killer, and it’s usual for this to go untreated in these women by their doctors who often are not aware that removing a newborn from a woman is a form of torture. And that’s only if she lives past the Clinical Depression and manages to struggle with her PTSD and not top herself in despair.

    Do you know what the follow up care is for such women? There isn’t any. Infact it’s pretty common for social services to leave her completely alone… as if they are just waiting for her to die.

    I mention this because people get this daft and completely false picture from TV drama of what it’s like for a woman to have a child taken from her, and they blithely propose that if a woman can’t are for her baby then instead of an abortion the child should simply be removed and adopted. They tend to think that after a couple of weeks of some mild sadness she’ll just rationalise the experience, forget about it, and bounce back, but this is so far from the truth it’s inexcusable.

    Instead of TV drama informing your opinion – this is the reality:

    “Afterwards – I wept constantly. I can’t recall much after that. My brain switched off. I went straight home and walked around the house. My mental and emotion state was completely reduced to that of an animal. No cognition at all. Everything was completely black for me and I just wanted to be with my child. I thought about killing myself so I could watch over her in spirit. I had the babygrow she’d been in and I’d take it out so I could smell her baby scent. I wandered around aimlessly. I couldn’t sleep. I just wanted to die.”

    And many many women do die. This is one of the reasons why we have abortion – to prevent more women from dying alone, unheard of, with the real cause of their deaths going unrecorded by the state.

    Have a nice day.

  12. This looks to have derailed the discussion away from the role of physicians in enabling what looks to be an abusing of women, but . . .

    @Alrah: Focusing on the beneficial effects of abortion in the lives of women (“preventing more women from dying alone”, etc.) is a losing rhetorical position in this debate. Those sympathetic to the pro-life position are so because they are sympathetic to the idea that abortion involves the killing of an innocent person. What ever the suicide numbers are (which as you point out says as much about the lack of support services as anything), they will pale in comparison to the number of aborted fetuses. Similarly, appealing to high incidences of clinical depression just sets up the comparison between that and the (supposed) deaths of millions of innocent people. Clinical depression loses, there.

    Defenses of abortion seem better suited to rights-based arguments, as opposed to social utility/consequentialist ones.

  13. Hi ajkreider,

    I’m not so sure. Re: convincing die hard anti-abortion folks seems to be a lost cause regardless of whether you argue rights or effects. I do find it pretty telling that anti-abortion people also mobilize a large array of (false) effects as well, e.g., that women generally regret abortion or become very depressed after abortions or are at high risk for sterility/breast cancer/etc. if they have an abortion.

    Furthermore, we can run your line against a rights based view as well: Fetuses are innocent persons with a right to life. Generally, rights to life trump lots of other rights. Etc.

    One key aspect of certain sorts of conflict of rights arguments is the degree of imposition on a rights holder. Public health measures are often like that. We can reasonable “imprison” (i.e., involuntarily confine) innocent infectious people based on the degree of risks involved (and the relatively minor harm endured).

  14. ajkreider – The only figures available are from Australia.

    “Female suicide rates in Australia have remained relatively constant since 1900, except for a gradual increase through the 1950s and 1960s, when the rate doubled. By 1985 the rate had declined to previous levels. (Hassan 1995). This peak in the female suicide rate in Australia coincides with the peak rate of adoptions.”

    http://www.originsnsw.com/mentalhealth/id2.html

    Women who make the difficult decision to abort a featus don’t do so simply because it is their right, but because they have looked long and hard at the consequences. The overwhelming majority of abortions are not as a consequence of being raped, but because they cannot bear to carry a child to term and have it adopted, yet all I hear these days is that abortions should be allowed because of rape. Why is this?

    If we are silent about the very real consequences to women who are denied abortion but cannot look after a child once it is born, then this gives the pro-lifers the upper hand to penalise women who haven’t been raped but if denied an abortion will face a life long battle with suicide (with or without support), a life long battle with depression, severe mental illness, personality disturbances, and chronic physical illness as a result of losing their child to adoption. Also – to be silent about the consequences just increases the stigma associated with women that have already had a child adopted because it sends the message that no-one is interested or cares about the consequences to them.

    The pro-lifers put the life of a featus above the life of the mother. Theirs is an illogical argument that would lead to the insanity and suicide of (using their own language) ‘persons’ in their efforts to save ‘potential persons’. I think we ought to get back to the reality of why we have abortion instead of resorting to cuckoo land arguments with our own brand of cuckoo. We let down doctors when we back away from the facts.

    These people who argue pro-life rhetoric are simply doing so because they’re playing the blame game and want a whipping post to release some of their repressed anger on. They get off on blaming people. If it wasn’t abortion then they’d find something else to get righteously angry about because they enjoy it. There’ll never be an argument that will satisfy because it’s not really about abortion for them – it’s about their own anger and finding someone to blame so they can feel justified in their vitriol. And that’s another plain fact of the matter.

  15. “instead of resorting to cuckoo land arguments with our own brand of cuckoo”

    should have read:

    instead of *retorting* to cuckoo land arguments with our own brand of cuckoo

  16. Bijan,

    If the bad psychic consequences of restricting choice are irrelevant, so too should be the bad consequences of permitting it.

    Treating the psychic consequences as relevant often puts us in absurd positions. In response to the claim that some women regret abortions, I’ve seen friends reply that it’s just not true, women don’t regret abortions! But if you think about it, of course there are women who regret abortions. A lot of people get abortions, and a lot of people regret choices about comparably life-affecting events. It would be an enormous statistical anomaly if no one who got an abortion ever came to regret it. If you treat those concerns as morally salient, you find yourself having to defend a lot of ground you never needed to cover in the first place.

    The real point is that it’s not the state’s business to protect you from making decisions you might later come to regret, especially when one has good reasons to make such a decision and no overriding moral claims from others. Is there any number of regretted abortions at which point that argument for criminalization would become compelling?

    While we’re clearing the air, the same can be said for some other pro-choice rhetorical strategies which seem to me to miss the point of the debate. The slogan “trust women”, for example, strikes me as seriously wrong. “Trust X”, where X is a large group of people who can perform action Y, is nowhere near an argument for the legality of Y. It either presumes that women as a group are monolithic in their view of abortion, or endorses the Victorian notion that women are delicate snowflakes of moral sensibility, incapable of acting wrongly.

    Ultimately, I think JJ Thomson basically nailed it: the question of abortion can be reduced to two questions: (1) is a fetus a person, and if so, (2) when is it ok to kill a person? Where you write:

    Furthermore, we can run your line against a rights based view as well: Fetuses are innocent persons with a right to life. Generally, rights to life trump lots of other rights. Etc.

    this argument fails when you try to flesh it out, if you have the right answers to (1) and (2). If that argument did not fail, then it would succeed, which would mean that the pro-choice position is wrong. Are you suggesting that the argument does succeed, and therefore that the entire project of a rights-based defense of abortion is mistaken?

    PS: Certainly deontologists are able to justifying public health measures: there is a right not to be deliberately infected by dangerous pathogens which is stronger than the right to go where one pleases.

  17. Hi synapseandsyntax,

    If the bad psychic consequences of restricting choice are irrelevant, so too should be the bad consequences of permitting it.

    ?? My understanding is that, empirically, women generally don’t regret their abortions, certainly no where near in the ways put forth in anti-abortion arguments. If there were severe enough effects that would strengthen the case.

    Treating the psychic consequences as relevant often puts us in absurd positions. In response to the claim that some women regret abortions, I’ve seen friends reply that it’s just not true, women don’t regret abortions! But if you think about it, of course there are women who regret abortions. A lot of people get abortions, and a lot of people regret choices about comparably life-affecting events. It would be an enormous statistical anomaly if no one who got an abortion ever came to regret it.

    You don’t need to say that no woman ever regrets or is even severely distressed by having had an abortion to dispute that abortion is abnormally or serverely psychically bad for women. From Wikipedia:

    In 1990, the American Psychological Association (APA) found that “severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses.”[6] The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that termination of a first, unplanned pregnancy did not lead to an increased risk of mental health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties.[10][11] A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while studies with methodologic flaws and other quality problems were more likely to report negative consequences.[12]

    So, abortion does not seem to be a risk factor for mental health problems (contrary to many claims). (I probably shouldn’t have introduced “regret” per se, since that’s a bit squishier and probably less documented. So I’ll stick with mental health.)

    If you treat those concerns as morally salient, you find yourself having to defend a lot of ground you never needed to cover in the first place.

    Aren’t they morally salient? They seem so to me. I agree that tactically, it may be unhelpful, but I don’t know it’s any more helpful not to rebut claims about e.g., “post abortion syndrome”.

    The real point is that it’s not the state’s business to protect you from making decisions you might later come to regret

    Well, that’s certainly a key point! I agree. And yet if women systematically came to seriously regret (unto having clinical mental health issues) abortion, that would be relevant to its regulation, wouldn’t it be? It’d certainly be relevant to how the medical profession would treat it. If women just came to regret it as some people come to regret tattoos or piercings, then, obviously, state intervention would be nuts.

    especially when one has good reasons to make such a decision and no overriding moral claims from others. Is there any number of regretted abortions at which point that argument for criminalization would become compelling?

    If it’s “mere” regret (a la an unwise tattoo), then I’d say no. If the procedure has a serious elevated risk for various sorts of morbidity and mortality, then I’d still say no to criminalization, but I’d also expect that doctors would be more hesitant.

    Are you suggesting that the argument does succeed, and therefore that the entire project of a rights-based defense of abortion is mistaken?

    I don’t think so. I find Thompson’s argument pretty compelling, myself. I wasn’t trying to cast doubt on it, but on ajkreider’s anti-consequentialist arguments. I think they too fail when you flesh them out. I.e., the consequentialist arguments are pretty good.

    To put it another way, I think easily available abortions win on both the rights respecting and the social policy front. Furthermore, I think those aspects are intertwined to some degree. If something turns out to be bad enough social policy, it might weaken rights claims. (Even morally!)

    Certainly deontologists are able to justifying public health measures: there is a right not to be deliberately infected by dangerous pathogens which is stronger than the right to go where one pleases.

    How am I “deliberately” infecting anyone by not staying secluded? I don’t restrict your movements in any way. I’m not intending to infect you (my infectiousness isn’t directly under my control; presume I’ve taken the requisite drugs). I’m not even trying to infect you (i.e., I don’t sneeze on you). You can walk around in an impermeable suit if you’re really concerned about it. Etc.

  18. I LOVE civil disobedience for a good cause. Point #4 in the post is SO Wachowski brothers! I’d be more than happy to sit still while Dr. McDreamy probes my nose, or some other part that would be obvious to another doctor is not a uterus. Ear, armpit, what have you. AS IF anybody but a doctor can tell what’s on those things anyway. Dude could even get creative with clay or something. Imagine the market for phony ultrasounds? An open-minded gal could get rich rich rich selling fake pictures of her ladyparts!

  19. Hi Bijan,

    Sorry, my first sentence suffered from inversion. should have read: “If the bad psychic consequences of permitting choice are irrelevant, so too should be the bad consequences of allowing it.”

    I guess if there are specific false medical claims being promulgated, it makes sense to refute them for the same reason it makes sense to refute any false medical claim. And if abortion did induce some medical syndrome, patients have a right to know about the risks.

    But neither of those points seem to bear on the basic moral case: it seems to me that once we understand what abortion is, (and maybe know some rudimentary human developmental neurology), we should be in a position to say whether it should be legal or not. Even if abortion were guaranteed to cause medical complications yea unto clinical depression, I guess I still don’t see how that weakens the case for legalization. Many drugs cause severe complications, but we don’t criminalize their use if you have a good reason to take them. Indeed, the entire debate hinges on whether there is ever a sufficiently good reason for an abortion. Maybe I’m failing to consider some compelling scenario under which medical complications would clearly weaken the case for legalization?

    To get back to ajkreider’s point, what the consequences are depends on the ontological question about personhood: if you think that a fetus is a person, then claims about the harms of post-partum depression will strike you as very weak sauce in comparison to the harm of murder. So regardless of the salutary social benefits of legal abortion, I don’t think that relieves us of the burden of explaining why abortion isn’t murder.

    In the public health example, “deliberately” should be replaced by “knowingly”. If I hop on a crowded subway when I know I have swine flu, I may not desire to cause anyone to be infected, but I’m still acting so as to cause a lot of people to get very seriously sick, in a way that I can reasonably foresee. While we could think of all sorts of crazy corner cases (I could roll around in an hermetically sealed hamster ball…) it seems reasonable to say that I act wrongly by knowingly spreading swine flu because other people have some sort of right not to have their health needlessly endangered.

  20. So now the moderators are leaving my cheeky comments up, and deleting the following explanatory comments that I preface with “but in all seriousness… Dr. Anonymous had a great idea and here’s how we can help…”

    That’s a really odd way to moderate. I am SO outta here.

  21. Sorry, my first sentence suffered from inversion. should have read: “If the bad psychic consequences of permitting choice are irrelevant, so too should be the bad consequences of allowing it.”

    I guess since I don’t think they are irrelevant either morally or legally on either side that the inversion doesn’t matter too much for me ;)

    Even if they are irrelevant as a matter of justice, they would still be relevant to benevolence.

    Even if abortion were guaranteed to cause medical complications yea unto clinical depression, I guess I still don’t see how that weakens the case for legalization. Many drugs cause severe complications, but we don’t criminalize their use if you have a good reason to take them.

    Don’t we? We criminalize all sorts of use of all sorts of drugs (from heroin to marijuana) and hugely regulate the rest of their use because of (putative) bad effects. I’m not in favor of such criminalization, but don’t think that heavy regulation of, for example, heroin is a bad idea. I do think that the general social costs of the current way we regulate cocaine use is relevant for assessing the reasonableness (and morality) of those regulations. Similarly, I think the actual outcomes of abortion criminalization (or regulation as were seeing) are relevant. That doesn’t mean that they are simply determinative of a judgement, of course.

    To get back to ajkreider’s point, what the consequences are depends on the ontological question about personhood: if you think that a fetus is a person, then claims about the harms of post-partum depression will strike you as very weak sauce in comparison to the harm of murder. So regardless of the salutary social benefits of legal abortion, I don’t think that relieves us of the burden of explaining why abortion isn’t murder.

    I don’t think anything I wrote disputes this variant. But merely explaining that it’s not murder does seem to settle the policy. Isn’t the whole situation we’re discussion not outright criminalization but every more burdensome regulations that are design to reduce the actual incidence of abortion and/or increase the unpleasantness of it? It seems like the outcomes matter at least there.

  22. The examples I had in mind were more like radical therapies for cancer, where the hope is that the drug kills the tumor before it kills you. It might have certain and severe side effects, but the standard of informed consent typically suffices to justify the practice of giving people drugs that might kill them. To take a less extreme example, people undergo general anesthesia, which is never good for you and always carries some risk of severe complications, for cosmetic surgery. This strikes me personally as a bad idea, but it’s a risk we’ve left up to individuals to tolerate or forego.

    Isn’t the whole situation we’re discussion not outright criminalization but every more burdensome regulations that are design to reduce the actual incidence of abortion and/or increase the unpleasantness of it?

    I think this conversation is due to Alrah’s mention of the anguish some mothers feel at giving their children up for adoption, and ajkreider’s observation that this argument is unlikely to cut ice with anyone who doesn’t already agree with the pro-choice position.

    The more I think about it, though, the more suspicious I am that the leadership of the mainstream pro-life movement are really motivated by the belief that a fetus is a person at all. For all my pleas for charity and good faith interlocution on this blog, I grant that this is a strong charge, but practically none of the positions held by such organizations are consistent with the aim of reducing the number of abortions performed.

    That chart actually omits the best example of this phenomenon, which is IVF. Since the procedure typically produces 25-50 fertilized embryos which are usually donated to scientific research or destroyed, it should be the moral equivalent of 25-50 abortions. Moreover, political support for IVF is much less polarized and and less organized than support for abortion. So shutting down IVF should be an obvious low-cost high-reward play for the pro life movement. But although you hear some pro forma criticism of it now and then, it’s never been the subject of serious legislative action (AFAICT). The only remaining explanation is that the people who tend to do IVF are ‘the right sort of people’ whereas people who procure abortions are godless sluts.

    So while I wouldn’t want to claim that there are no principled, consistent opponents of abortion, I tend to doubt that the movement leadership really cares that much about the actual issues of personhood and just killing. That’s not to say that those issues aren’t very much worth thinking through.

  23. Wow. Fp keeps deleting my comments. It looks like I’ll have to attempt to address Bijan on his blog if I want to chat with him about this or any other topic. I’m glad the med school student who reposted this article wasn’t in such a hurry to dismiss me. My comment is still up on his site. I hope it helps somebody.

    Is it ok if I continue to poke around your blog Bijan? Or do you feel bullied when I’m around? ;-)

  24. The examples I had in mind were more like radical therapies for cancer, where the hope is that the drug kills the tumor before it kills you. It might have certain and severe side effects, but the standard of informed consent typically suffices to justify the practice of giving people drugs that might kill them.

    I think, in general, if there’s no reasonable hope of benefit, standard medical ethics would forbid that.

    This just seems to be a case where the hoped for benefit outweighs the harm. There are plenty of cases where the structure is different and the practice forbidden: Suicide, amputation of a major limb for cosmetic reasons, unproven treatments, drugs that are not approved, etc.

    “Informed consent” relies heavily on deferring a good chunk of the being informed to the medical professionals and establishment.

    So, I still don’t think that the (general or typically) outcomes of a permissive vs. restrictive abortion policy are (legally or morally) irrelevant. This is why anti-abortion folks make up high rates of negative incidents and ignore the relative risks of pregnancy vs, (various sorts of) abortion.

    Now, I happen to think that the rights aspect of it are pretty strong, all by themselves. So, I’m not really against relying mostly on that.

    The more I think about it, though, the more suspicious I am that the leadership of the mainstream pro-life movement are really motivated by the belief that a fetus is a person at all.

    That’s a widely shared, and long held conviction for lots of good reasons. The fact that they tend to target doctors for criminal sanctions and not the women strongly suggests it (i.e., if it were murder, you’d treat the person who ordered the hit as severely as the person carrying it out).

  25. To talk about “personhood” as a binary here is, of course, deeply mistaken. There is a continuum through which all the various elements of personhood gradually develop, beginning with the single-celled organism and culminating in the fully-educated, fully-realized adult human (past the age of consent and possessing worldly wisdom, etc.).

    An interesting fact, to my mind, is that the same continuum exists whether you look at the embryological development of the individual human, or instead look at the evolutionary history of the development of the human species. In either case, you can go back, step by step, to simpler and simpler organisms, until you get to a single-celled creature, with no particular point at which to say you have crossed the line separating person from non-person.

Comments are closed.