Holy Bible (any translation)

• Genesis 1–3
• Genesis 9
• Exodus 20
• Romans 1, 2, 13
• James 2, 3

Didache (50-100 AD)
Chapter 5: The Way of Death

Sometime in 2007, when Robert P. George and I had agreed to publish Embryo: A Defense of Human Life with Doubleday, our editor, Adam Bellow, got in touch to request a change to the beginning of the book. I no longer have the correspondence but the substance of the complaint was that our opening pages were . . . dry. I am confident that the complaint was just, and can guess that we opened with some abstract claims about justice. That is an occupational hazard for both of us.

In search of something with a bit more zing, I was astonished to come upon the story of Noah Benton Markham. Noah had been among 1,400 cryopreserved embryos whose lives were threatened by Hurricane Katrina, and he was among the lucky ones to be rescued by police officers using flat-bottomed boats. He was born sixteen months after Katrina’s devastation, his name an obvious tribute to his unusual history.

We opened Embryo (later updated in a second edition from the Witherspoon Institute) with Noah’s story in order to make a simple, but essential, point: it was Noah who was rescued by those police officers (combined forces from Illinois and Louisiana). It is true that Noah existed at that time in the very earliest stages of human life, as an embryo; and true also that he existed in a state of suspended animation, cryopreserved in anticipation of the possibility of eventual implantation in his mother’s womb. But, as we noted,

[I]f those officers had never made it to Noah’s hospital, or if they had abandoned those canisters of liquid nitrogen, there can be little doubt that the toll of Katrina would have been fourteen hundred human beings higher than it already was, and Noah, sadly, would have perished before having the opportunity to meet his loving family.

The story of Noah was recalled to my mind in recent days by the announcement that the Alabama Supreme Court had ruled that cryopreserved—frozen—human embryos are to be considered “unborn children” under the 1872 “Wrongful Death of a Minor Act” that “allows parents of a deceased child to recover punitive damages for their child’s death.” That act contained no exception for in vitro embryonic human beings, and the Court thus ruled that the “Wrongful Death of a Minor Act applies to all unborn children, regardless of their location.”

There is no doubt that the ruling opens up many legal and policy difficulties that remain to be addressed. But those final four words of the Court’s opening paragraph, “regardless of their location,” get to the heart of the most important biological and moral issues regarding in vitro embryos: location does not matter either to the humanity or to the moral status of those embryos. These were points that Professor George and I argued at length in Embryo, and it is worth returning to those arguments briefly, since the Alabama Court’s judgment is being met at many turns with incredulity: how can a cryopreserved in vitro embryo actually be a human being, with a claim to the same kind of respectful treatment to which you, the reader, or I, the author of this essay, are entitled?

It is necessary to begin, of course, with the question of the in vivo embryo, the result, after sexual intercourse, of the fertilization of an oocyte by a sperm cell. Is that single-celled entity, the zygote, a human being? As we noted in Embryo, and many times since, the verdict of every embryology and developmental biology textbook that we consulted is affirmative. As Moore and Persaud write in The Developing Human, “This highly specialized totipotent cell marked the beginning of each of us as a distinct individual.”

The reason for the uniform convergence by experts in biology is quite straightforward: at fertilization, two gametic cells, the sperm and the oocyte, cease to exist, and a new single-celled organism comes into being. This zygotic individual is biologically distinct from his or her parents and is possessed of both the genetic and epigenetic starting points necessary to be the primary agent of its own growth and development to the next stages of human life.

Of course, the zygote, like any human being, requires that certain other conditions be met in order for that growth and development to be possible. Deprived of hospitable environmental conditions, nutrition, and the love and care of other human beings, no human being will flourish, and if the circumstances are sufficiently hostile, they will die. The embryo is no different: in the absence of a uterine home, embryos will eventually arrest their growth or, as in an ectopic pregnancy, put both their own life and the life of their mother at risk.

Certainly, a petri dish is an inhospitable environment for continued growth; nor does the technology currently exist to sustain the embryo’s life for very long outside the mother. Yet there is no question, biologically, that the embryo that, as a result of in vitro fertilization, exists in a petri dish is, if implanted and gestated, the same human being who will eventually come to term, then grow as an infant, adolescent, and beyond. No biological change in the embryo takes place at implantation, only a change in “location.”

Indeed, it seems clear that in time there will be artificial wombs, in which artificially conceived embryos can receive something like the nutrition and support they would be given in utero, such that they can be gestated to the point of viability. The biological continuity, the lack of any real or substantial change, would be visibly apparent to all. Just as it was Noah who was rescued, so it would be James, or Mary, who would be nurtured from the zygotic state to the point where he or she would be capable of life outside the womb.

Does cryopreservation make any difference to the issue? It is hard to see how it could: the embryo that is conceived in vitro is a distinct and individual human being; its metabolism is then radically slowed through submersion in liquid hydrogen, and it is left undisturbed for some period of time, perhaps years, before being resuscitated at normal temperature. There is now an embryo ready for implantation. Is it a different embryo from the one that was frozen? That would be quite a trick! The newly resuscitated embryo has precisely the same genetic profile, the same physical makeup, and occupies the same physical space as the embryo that was frozen. How could it be a different entity?

But then, if the resuscitated embryo is the same human being as the embryo before freezing, then the frozen embryo is that very same human being as well. The human being does not cease to exist or die, only to come back to life at room temperature. Such gaps in an organism’s existence are unknown to science.

Change a human being’s location, and you will often change what is needed for that human being’s continued survival. A human being underwater for an extended time needs oxygen tanks; a human being in the Arctic needs a heater; a human being in space requires a tremendous amount of technological assistance to stay alive. The embryo is no different: removed to, or created in, a petri dish, the embryo must either be implanted, grow in vitro until growth is no longer possible, or be frozen in order to stave off death. But none of that makes any difference to what it is: it is an unborn child, regardless of location.

And if we think but a bit more on the matter, it is clear that such changes of location can make no difference to the embryo’s moral status either. The moral position defended in Embryo is one founded on a recognition of the radical equality of all human beings. You and I, after all, have a right to respectful treatment, including a right not to be killed at will, that does not vary in consequence of the many differences that exist between us—differences of age, intelligence, awareness, status, or appearance. What can such an equality of rights be founded on except the one thing we do have equally in common: our humanity?

Location is simply one more of those many factors that make no difference where the most foundational moral principles are concerned. The human embryo is a human being, whether in utero, undergoing cell division in vitro, or temporarily (or permanently) in frozen stasis in a “nursery,” as the Alabama Supreme Court tellingly, but somewhat ironically, calls it.

The consequences for IVF as currently practiced are clear enough. Leaving aside moral concerns with the process itself, as a form of baby making, it is clear that the IVF industry in the U.S. has been in the business of creating perhaps millions of embryonic human beings that will never be given the chance to grow and develop their human potential, but will instead be frozen or discarded. As one medical website put it in reporting on the Alabama ruling: “Embryo loss is integral to IVF.”

That is the plain truth, which needs to be acknowledged in conjunction with the plain truth affirmed by the Alabama Court, though denied by many: those embryos are “unborn children, regardless of their location.”

In 2016, Canada legalized euthanasia for adults suffering severely and incurably near the end of life. Four years later, it legalized euthanasia for adults even if death is not “reasonably foreseeable.” Next year, euthanasia is set to become legal also for adults whose sole medical condition and source of suffering is mental illness. Recommendations have been made to legalize euthanasia for minors whose death is “reasonably foreseeable.” The organization that regulates physicians in the province of Quebec has suggested that euthanasia should be available for infants with severe disabilities or illnesses that render them unlikely to survive.

Between 2016 and 2022, close to 45,000 Canadians died through what is officially termed “medical assistance in dying,” or MAID. As of 2022, euthanasia was virtually tied with cerebrovascular disease as the fifth-leading cause of death in Canada (with only accidents, COVID-19, cancer, and heart disease causing more deaths). In each of the preceding years starting in 2016, the number of deaths by euthanasia grew significantly. Between 2019 and 2022, the average increase was just over thirty-one percent per year.

These statistics reveal disturbing truths about what happens when a society legalizes euthanasia. Canadians have been told by advocates, legislatures, and courts that euthanasia is a basic good. But in truth, euthanasia teaches that human dignity is degradable rather than enduring. It creates hierarchies of personhood by calling into question the worth and value of certain individuals based on their strengths and abilities—things that, by nature, are mutable. This is always and everywhere a fundamental injustice. In Canada, this injustice is surfacing in deeply damaging ways.

These warnings are not new. When, in 2021, Canada was about to expand euthanasia to scenarios in which death is not near, three UN officials—including the special rapporteur on the rights of persons with disabilities—wrote to the Canadian government to express concerns about how this step would affect individuals in Canada living with disabilities. The authors noted that if euthanasia is “made available for all persons with a health condition or impairment, regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.”

This point is accurate, but it has a broader reach. When euthanasia is legalized, the social assumption that it is better to be dead than to continue living takes hold in all the scenarios in which euthanasia is legal. And one must ask: what factors would lead us to think that it is better to be dead than to continue living in these scenarios? Advocates for euthanasia will point to quality of life, autonomy, dignity, pain, and suffering. But the deeper message embedded in these advocates’ words is that some of us are no longer persons. If we find ourselves eligible for euthanasia, we are not really living anymore. And if that is true, euthanasia seems like a sensible choice.

When it comes to euthanasia, quality of life and autonomy have been inextricably linked to dignity, which has affected how we understand personhood. As my quality of life and autonomy decline, so too does my dignity. As my dignity declines, so too does my personhood. Once my personhood has sufficiently faded away, it is cruel for the state to stand in the way of letting me die. In fact, it is cruel for the state to refuse to help me die. Enter euthanasia, provided through the healthcare system.

We are witnessing, in other words, a reconstruction of personhood—a reconstruction that began before euthanasia was legalized in Canada or other countries. This reconstruction professes that, while some of us may technically be here, we are not here in any meaningful sense. Legalizing euthanasia is not only a natural plank of this reconstruction. This step also accelerates this process and takes it to new places, all the while claiming to render societies and each of us more respectful of human rights and thus more humane.

As it turns out, the vision of personhood conveyed and reinforced by euthanasia has led to violations of the same rights that were allegedly violated by a ban on euthanasia—rights that speak to personhood. In a 2015 case, the Supreme Court of Canada relied on the constitutional right to “life, liberty, and security of the person” to strike down Canada’s ban on euthanasia. This ruling led to the legislation of 2016 that legalized the first version of euthanasia across Canada.

Since 2016, it has become clear—if it wasn’t clear before—that legalizing euthanasia endangers life, liberty, and security of persons. If it is easier to be euthanized than it is to find adequate or affordable housing, personhood properly understood is far from being respected. The same is true when euthanasia is offered to veterans contacting the government for assistance, when euthanasia is viewed as the only viable option by a quadriplegic mother who cannot find adequate support to live with her disability, or when public health authorities provide information sessions on euthanasia to pensioners as they contemplate their retirement years. When a federal minister admits that in some parts of Canada it is easier to access euthanasia than it is to obtain a wheelchair, alarm bells should be ringing.

And if even one person in Canada has chosen euthanasia because that person considers him- or herself to be a burden on others, or because he feels isolated and lonely, Canada is failing to protect the life, liberty, and security of persons. Faced with these realities, one of the rationales for a total ban on euthanasia—namely, the practical impossibility of avoiding abuse and misuse—comes into clear focus.

A case in point is that of Kathrin Mentler, a woman in her thirties who in June of this year admitted herself to a Vancouver hospital due to depression and suicidal thoughts—conditions she has lived with for some time but that had become more acute owing to a recent traumatic event. Once at the hospital, Mentler was taken to a room where a clinician told her that the healthcare system is “broken” and that the wait time to see a psychiatrist would be significant. The clinician then asked her if she had ever considered euthanasia, noting that it would be more “comfortable” than committing suicide through overdosing on medication, a concern that Mentler specifically had in mind when she went to the hospital that day. In her words, “I very specifically went there that day because I didn’t want to get into a situation where I would think about taking an overdose of medication.”

For decades, societies like Canada have rightly spent time, money, and resources on suicide prevention. Mentler’s case reveals a disturbing shift on this front: she wished to live, yet death was suggested to her. While the exchange between Mentler and the clinician was brief, and the hospital says that the question about euthanasia was simply a way to evaluate Mentler’s level of suicidality, the notion that Mentler’s personhood was fading away seems to have been at work. If a society is offering euthanasia as a solution to persons who are suicidal, we have arrived at a destination where personhood has been reconstructed beyond recognition.

Mentler’s case is also revealing because euthanasia was brought to her attention at a time when she appeared to be ineligible for it. Euthanasia for persons suffering solely from mental illness will not be available in Canada until next year. Perhaps the step of legalizing euthanasia for individuals in other circumstances—in circumstances that are currently covered by the law—has activated a radar within some Canadians for other cases in which euthanasia should be legal. The legislation of 2016 taught us the basics of when euthanasia should be granted, and now we are applying these lessons to novel situations.

That radar now seems to be picking up members of society who find themselves in particularly dire straits, such as persons who are homeless and struggling with unemployment, mental and physical illness, and addiction to drugs or alcohol. Areas of Canadian cities where these challenges are especially visible, such as the Downtown Eastside of Vancouver, are now being spoken of in the same breath as euthanasia. One recent article suggests that individuals with substance use disorder may qualify for euthanasia once mental illness is added to the eligibility criteria. The article, in making this forecast, also gestures to how euthanasia is eroding the concept of personhood. As an advocate for the Downtown Eastside quoted in the article puts it, to render individuals afflicted by substance abuse eligible for euthanasia is to say that these individuals “aren’t really human.”

In Canada, we are witnessing the powerful ramifications of legalizing euthanasia, euphemistically calling it “medical assistance in dying,” delivering it through a publicly funded healthcare system, wrapping it up in distorted understandings of dignity and rights, and demonizing individuals and institutions that believe (and wish to act on the belief) that euthanasia is killing and a mark of an uncivilized and inhumane society. This is a cautionary tale that must be told.

Some euthanasia advocates will say that these statements are hyperbolic fearmongering. They said the same when critics of euthanasia warned that opening the door in 2016 would lead to euthanasia in other cases and contexts: where death is not foreseeable, when minors are involved, in cases of mental illness, and beyond. And look where we are, less than a decade later. Forget the slippery slope. This has become a sinkhole.

Much work must be done to restore the proper understanding of personhood—what it means to be human—in societies that permit euthanasia. This work will take not just years, but decades and possibly even longer than that.

But that work must begin somewhere. I believe it begins with telling the truth. Euthanasia does not erase a shell of a person. It erases a person, each and every time.

United Nations Charter

Preamble