Metastatic Gestational Trophoblastic Disease: God’s Little Miracle?

11Aug08

a religio-legal-scienterrific thought problem

The fundamentalist pro-life stance that “life begins at conception” carries with it, intentionally, a host of legal and social implications, including that a fertilized ovum cannot, at any stage of its development, be terminated without due legal process. But if life begins at conception, where does it end? To put it more specifically, is a molar pregnancy a person?

The trophoblast is the layer of cells surrounding a blastocyst. Its initial function is to erode the endometrial lining sufficient for the blastocyst to attach; later, the trophoblast differentiates into the fetal external support structures, including the umbilicus, placenta, and amniotic sac. In metastatic gestational trophoblastic disease, instead of forming these support structures, the trophoblast forms a layer of metastatic (cancerous) cells around the developing blastocyst. The blastocyst ceases development, and a tumor, rather than a human embryo, lodges in the uterine wall.

Assuming arguendo (as this article does throughout) that “life begins at conception,” then a number of disturbing conclusions arise. First, life is already well on its way once the developing embryo reaches the blastocyst/trophoblastic stage. Second, “life” presumably includes all cells divided since the moment of fertilization, including those that develop into structures ultimately separate from the full-term infant – such as the trophoblast. Which in turn leads to the conclusion that disposing of the placenta post-delivery is a form of assault.

Placental mayhem aside, however, the conclusion arises that the trophoblast, at least, is part and parcel of the “life” which began at conception, and therefore that a metastatic trophoblast is in some sense still “life” despite its malignancy. Therefore, when a metastatic trophoblast implants in the endometrium, it is “life” dependent upon the life of the mother, just as an embryo is, and cannot be disturbed without the benefit of legal process in the same way a noncancerous blastocyst cannot – despite its obvious threat to the life of the mother. (Whether a metastatic mass has a claim under the Americans With Disabilities Act for its obvious disability relative to a sound blastocyst is an intriguing question, but beyond the scope of this article.)

Unlike an ordinary pregnancy, however, the dependency span of a malignant mass is limited not by the ordinary gestation period but by the lifespan of the host. Presumably, the host would therefore have to be kept alive by any means, at any cost, in order to avoid impairing the malignancy’s “right to life” acquired at conception. Rarely has the right to life come up so squarely against the right to die. But any mother diagnosed with metastatic gestational trophoblastic disease who subsequently signed a DNR order or refused to accept medical care – indeed, one who refused to seek it despite the mere obstacle of its staggering cost – would surely be guilty at least of negligent homicide.

Ultimately, the problems revealed are less medical or legal than they are logical – there is a flaw in the initial presumption. To say “life begins at conception” is overly simplistic and, to put it delicately, complete bullshit. Yet this overly simplistic world leads by ruthless application of its own logic (no “emotional leftist hysteria” necessary) to the conclusion that women must be kept alive to feed malignant tumors for no other reason than that those tumors began as fertilized ova.

As unlikely as this scenario sounds, it remains in the realm of possibility as long as the faulty and simplistic premise that “life begins at conception” remains in play. Perhaps what “everyone knows,” that malignant masses are not “life,” is true. But then the idea that “life begins at conception” fails, for it has not answered the very question for which it was invented: when, in a continuous process of cell development, does “life” arise or not arise? If “at conception” remains the answer, then a molar pregnancy remains by definition a “life,” and chemotherapy becomes “murder” as surely as abortion does. Metastatic gestational trophoblastic disease, now more or less a treatable condition, becomes a death sentence – but not only for the blastocyst.

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One Response to “Metastatic Gestational Trophoblastic Disease: God’s Little Miracle?”

  1. Thanks for sharing explanations and writing this article. Looking forward to more of your stuff. Hopefully you continually update your homepage often since you have found a loyal visitor .


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