Dermoid cysts getting under Egnor's skin?

Michael Egnor is still upset. Earlier, he penned an inaccurate, misleading, and ⦠well ⦠egnorant defense of his views on abortion, responding to my critique of his claim that personhood is easy to define.

His earlier reply repeatedly and incorrectly attempted to associate the content of this blog with my employer. As the sidebar on every page makes clear, the opinions expressed here are not those of NCSE. People who try to tag content here as reflecting NCSE policy or views instantly lose a lot of credit in my accounting of their literacy.

Egnor continues that trend in his latest response, titled: National Center for Selling Evolution Science Education's [sic] Policy Director Josh Rosenau: It's Hard to Distinguish Unborn Children From Cancer. The errors certainly begin with the association between NCSE and my opinions stated on this blog, but he's also wrong in his paraphrase of my views. I have no problem distinguishing a fetus from cancer. Egnor's definition of personhood, however, fails in this task, a point I've made repeatedly. For instance, my previous reply explained:

I did not compare embryos to cancer or a parasite; I did suggest that Egnor's criteria for "personhood" invite such comparisons. I noted, after all, that it is "obvious that they are spurious"; neither Egnor nor anyone else thinks that way. The problem is with Egnor's claim that the moral status of "personhood" invests itself at conception. This view obliges us to ask what magic happens when sperm meets egg. He insists that this is not a metaphysical argument (ensoulment or some such), but simple biological fact. But what makes a fertilized egg biologically a "person," in a way that an unfertilized egg isn't, or that a cancer isn't, or that cell cultures in the lab aren't? I happen to think personhood is defined differently, and so these problems don't emerge for my definition. Egnor egnores this distinction, and fails in any way to clarify his own views, and how he would rescue them from what amounts to a reductio ad absurdum disproof.

Egnor evades this question by the simple expedient of egnoring that argument, and indeed the entire post containing it. His reply is a second attempt at attacking the first post, even though it would be more illuminating for all involved if he incorporated my explanations, clarifications, and rebuttals of his first attempt at addressing that post. But he has a reputation to live up to, and when people start associating you with "the egotistical combination of ignorance and arrogance," you gotta roll with it.

Predictably, Egnor's latest reply is filled with FAIL. For instance, he begins by trying to define his terms:

Biological science affirms that every fertilized human egg is a human (it has its own gender, unique DNA, and is no other species but Homo sapiens [sic]).

This is important for him to establish because he (a la Sam Harris) wants to claim that morality (at least in this case) is a purely scientific enterprise, and that his opposition to abortion is not rooted in religion, or supernatural claims about the soul, or even personal moral judgment. Just science. We'll assume he knows he meant "sex," not "gender," as sex is biologically determined, and gender is a component of a person's culturally constructed identity.

Let's skip, momentarily, past the enormous holes in this definition. Let's skip to the place where he tries to make clear how a cancer and a fetus are totally different. He's responding to my observation that cancers have different DNA, as do dermoid cysts and HeLa cells in culture:

What distinguish [sic] an unborn child from his/her mother aren't genetic differences; a child in the womb is not the same organism as his/her mother because the child and the mother are different members of the species Homo sapiens [sic]. Half the time, mother and child are not even the same gender. The mother is a human being and the child is a human being. They are not the same human being. The child in the womb is located within the mother's body and is dependent on her for many things. But location and dependency are not biological criteria for being a member of a species.

Six paragraphs earlier, genetic distinctness was one of the key defining factors for personhood. Now it doesn't count. Oops.

And gender (sex, really) doesn't do the job either. As he notes, that only differs half the time. Which means that he's now arguing for a definition in which every fertilized egg is a distinct person because a fertilized egg is a different member of the species Homo sapiens. Tautology much? To be discrete means being different (though not necessarily genetically different, I guess), and to be human means being Homo sapiens. Biological science doesn't affirm this, Roget's thesaurus does. Alas that it's a useless definition in practice.

The first definition he offered was useful in some sense. Different sexes and different DNA are measurable criteria. It doesn't help us determine whether identical twins are distinct persons, which should cause Egnor some concern, but it could be a useful start had he not since disclaimed both criteria.

Does a dermoid cyst meet Egnor's definition of personhood? I don't know, because there's not enough substance to the definition. What about HeLa cells? In both cases, he asserts that they are not morally "persons," but why not? He can't quite articulate a reason. They are, he explains, "not human beings." He never tells us how he figured that out. That's relevant not because anyone (including myself) would say that a cancer or a lab cell culture is a human being, but because he hasn't established how he would draw the distinction. Dermoid cysts are capable of developing all the tissues in a human body. They are genetically distinct. They are not generally malignant, and thus are not cancers. In some cases they develop structures identifiable as human teeth, human eyes, human limbs, etc. There is at least one report of a dermoid cyst forming "a small mass similar to a human body of head and single upper extremity."

Though he doesn't offer a clear criterion for making the distinction, Egnor does make this contrast, which would be more compelling of not larded with obvious errors:

A human being at conception will mature to a newborn baby and to an adult. A cancer is biologically, physiologically, biochemically, morphologically, histologically, phylogenetically, teleologically, therapeutically, and morally different from an unborn child.

i-b1e1c0a319bea3ee8ec7b62333537e9a-Screen shot 2010-12-19 at 1.57.44 PM.jpgTo the first sentence, we should note that a zygote often does not "mature into a newborn baby and an adult." The best available estimates suggest that as many as 70% of fertilized eggs naturally abort, either by failing to implant in the uterine wall, by being resorbed into the uterus after implantation, through miscarriage (often driven by chromosomal abnormalities), etc. This is of only modest import, except that, as the authors of the figure above note: "The majority of these losses occur prior to the time of the missed menstrual cycle, and are not revealed." (Macklon, Geraedts and Fauser (2002) "Conception to ongoing pregnancy: the 'black box' of early pregnancy loss," Human Reproduction Update, 8(4)333-343). If Egnor is right, we fail to mourn the majority of these human lives taken in the first month after conception. That no one seems deeply troubled by this fact suggests that our intuitive understanding of when a zygote becomes a person is more subtle than Egnor's hard and fast rule. In any event, it undermines Egnor's certainty that the conceptus "will mature to a newborn baby." Most don't. And if we're going to talk about the potential to become a newborn baby, then why not regard an unfertilized egg or sperm as unique human beings? Both are genetically distinct from the person producing them, are discrete from that person physically, and have the potential to become a newborn infant (contingent on various events). Again, I'm not saying unfertilized gametes are discrete human beings, just that Egnor's criteria don't get us to a useful distinction.

As to the second sentence in Egnor's contrast, he tossed in a bunch of different arguments, supported none of them, and failed to justify the relevance of any of them. Indeed, those arguments consist of a list of adjectives modifying "different": "biologically, physiologically, biochemically, morphologically, histologically, phylogenetically, teleologically, therapeutically, and morally." We'll ignore "biologically" for the nonce, since it's vague, and followed by various specific biological differences. We'll set aside "morally," because up to this point Egnor has insisted that he is only interested in biological differences, and that he isn't making an argument from moral philosophy. For the same reason, we'll set aside "teleologically." A claim of "phylogenetic" difference is unsustainable; dermoid cysts grow from human eggs, as do fetuses; cell cultures are not different from the tissue of the organism they were drawn from, and certainly aren't a new species (though HeLa generates some interesting questions on that front). Is he claiming a dermoid cyst is a different species? What about fetus in fetu?

As to the others, note that dermoid cysts produce histologically normal human tissue. They can produce eyes that are morphologically no different from that in a fetus. Their biochemistry is human biochemistry, as their physiology is human physiology. The hair and teeth and bones and skin and nerves they produce is produced the same way that human hair and teeth and bones and skin and nerves are produced. There may be a good argument in favor of these adjectives, but Egnor hasn't made it. Thus, saying that there is a "therapeutic" difference seems to beg the question, as he's saying we are always morally justified in removing a benign dermoid cyst with arms and eyes and hair and nerves and bones (even a skull), but never in removing even an undifferentiated mass soon after fertilization and implantation. That seems like exactly the question at hand, not a biological fact to be asserted. Nor is it an accurate description of current medical practice. It doesn't even match the traditional Judeo-Christian approach to pregnancy.

Actual biology continues to show that Egnor's supposedly clean distinction simply isn't. I mentioned fetus in fetu above, and that's a perfect case. Here, a fetal structure is found growing inside a child. The generally accepted explanation is that these structures are either highly developed dermoid cysts, or that the child and the fetus are twins, one of which surrounded the other during development. Medical treatment always calls for the surgical removal of the fetus in fetu. Medical papers on this phenomenon note: "It often is difficult to make a distinction between teratomas and vestigial remnants that result from abortive attempts at twinning." The doctors refer to the child in whom the fetus is growing as "the host," a term which caused Egnor some umbrage before. He'll be shocked to learn that they also describe fetus in fetu as "allowing 1 twin to parasitize the other."

Egnor insists:

Any competent biologist can distinguish an unborn child from cancer. Any competent pathologist can distinguish an unborn child from cancer. Any competent obstetrician can distinguish an unborn child from cancer.

And yet here are three pathologists explaining why it's hard to tell fetuses from tumors:

Fetus in fetu has classically been distinguished from teratoma [including dermoid cysts] in that â¦the former requires the presence of a highly developed and segmented axial skeleton. This distinction is somewhat arbitrary ⦠Our case [of teratoma] demonstrated a vertebral column, although it was not well developed. ⦠organogenesis has also been mentioned as a distinguishing feature between these 2 entities. A gastrointestinal system, central nervous system, genitourinary tract, respiratory system, and other less common organs including thyroid gland, liver, spleen, and lymph nodes have all been documented in fetus in fetu. ⦠fetiform teratoma usually does not have complex, well-developed organs. However, Kuno et al. described a fetiform teratoma with both a highly developed axial skeleton and organs that included a brain, eyelike structure, trachea, thyroid gland, blood vessels, gut, and phallus-like structure that contained spongy vascular (cavernous) tissue.

Fetiform teratomas must also be distinguished from ectopic pregnancies. All reported cases of fetiform teratoma are composed of mature tissue and present without placental or trophoblastic tissue. However, there have been 2 reported cases of umbilical cord structures described in fetiform teratomas â¦

In summary, we have described a fetiform teratoma, a rare form of a mature cystic teratoma that is highly developed and organized, resembling a fetus-like structure. The degree of organization and differentiation can vary, blurring its distinction from either fetus in fetu or ectopic pregnancy. Its diagnosis requires both a clinical history and thorough pathologic examination. Cytogenetic/mo- lecular studies may be helpful in distinguishing difficult cases.

So there are "difficult cases," cases which blur the line between tumors and fetuses. Would Egnor grant a right to life to any of these, since all must be surgically removed? An ectopic pregnancy is a fertilized egg which implants outside the uterus, either in the fallopian tubes, or in the abdominal cavity. Failure to remove it is often fatal, though a few cases exist where an ectopic fetus was removed surgically and then cared for like a premature birth.

The difference between these three fetuses or fetus-like structures does not consist of the major biological criteria Egnor tried to introduce. They are histologically, physiologically, and morphologically difficult to distinguish from normal fetuses, and indeed can show much more differentiation than an early embryo. Two of these are normal fetuses, and the only thing that distinguishes them from the fetuses Egnor would accord an inherent "right to life" is ⦠location. In fact, the only distinction between an ectopic fetus and a normal fetus is location.

But what does Egnor say about location?:

The child in the womb is located within the mother's body and is dependent on her for many things. But location and dependency are not biological criteria for being a member of a species.

This, of course, is the only mention of the woman carrying a pregnancy in Egnor's analysis. Here, she is reduced to her body, and even that is eventually trivialized as mere "location," as if location is trivial. But it simply isn't, as the case of ectopic pregnancy and fetus in fetu make clear. Location is Egnor's only argument for any distinction in those cases. A woman is presumably free to cause an errant fetus to be removed from her intestinal walls, aortic lining, mesenteric membranes, or fallopian tubes without moral consequence, but when the fetus is within the uterus itself, the woman must accept the medical risks thus posed. This is, to say the least, a strange way to think about things.
This is not to say that within another living thing and dependency upon her should inherently override our belief that an organism is, in some sense, a separate entity. I mean, male angler fish are still members of the same species after having been absorbed into a female's body. But the fact that a fetus is entirely contained within a woman's body, and entirely dependent on her for nutrition and immune defense, the fact that the woman's antibodies course through the fetus, that the fetal tissue is intertwined and inseparable from the woman's tissue, strikes me as biologically and ethically significant. Because it's one thing to assert that an undifferentiated mass of cells has some vague "right to life," and quite another to insist that a woman must sacrifice her own right to life because of the rights Egnor grants that cell mass intertwined with her uterus (but not to the same cell mass when entwined with her fallopian tubes or intestinal walls).

The abstract moral status of an embryo is more relevant in discussions about embryonic stem cell research, where an 8-cell mass is destroyed to extract totipotent cells for use in life-saving research. But in discussing whether a woman has a right to an abortion, the moral status of the embryo is no more than half of the equation. That embryo is connected to a person, and the moral status of the person in which the embryo is growing is indisputable. In seeking a balance between an entity of unquestioned personhood and another entity of ambiguous personhood, I'll side with the person.

This is not a biological argument, and it isn't one that biology can resolve. Biology can inform our choices, helping us decide how much more to weight the woman's needs over those of an embryo. But Egnor's belief that the embryo's needs outweigh the woman's cannot conceivably be justified by biology. Personhood is more than biological. It's is an ethical judgment, and implicates more than just cellular physiology or histology. It's about how a being interacts with the world (or preferably, how beings at a given stage in their growth are generally capable of interacting with the world).


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By informania (not verified) on 19 Dec 2010 #permalink

I'd love to see Egnor explain what should be done with a woman whose pregnancy mysteriously stagnates at, say 6 weeks. No development, no change over time, the woman simply has a permanent pregnancy. And to eliminate some wiggle room, let's say the fetus is nonviable. Removed, it will cease to be. Would Egnor truly argue that this fetus has full personhood status and cannot be removed? And if not, why not? Since when does personhood depend on whether one's status might change in the future?