Summary: Chapter VIII (I)
Protagonists in the shade (I): Edward C. Hughes y Raymond Holden
I. Edward C. Hughes and obstetric-gynecological terminology
Edward C. Hughes was one of the creators in 1951 of the American Academy of Obstetrics and Gynecology, which soon after was renamed the American College of Obstetricians and Gynecologists (ACOG). He chaired the ACOG in the period 1962-1963, and became president of its Terminology Committee in 1965.
The terminology changes sponsored by Hughes have had a broad ethical impact, with both doctors and the general public. The Committee produced two publications: the Bulletin of Terminology No. 1 (1965), a loose leaf folio inserted in the journal Obstetrics and Gynecology, was sent to the members of the College “for information and consideration”. The second publication was the book, Obstetric-Gynecologic Terminology (1972).
New Definitions With Ethical Repercussions
CONCEPTION. Bulletin: “It is the implantation of the fertilized egg. This definition has been deliberately chosen because the union of the sperm and the oocyte cannot be detected clinically unless implantation occurs.” The corresponding entry in Terminology says: “It is the implantation of the blastocyst. It is not synonymous with fertilization. SYNONYMOUS: Implantation.”
EMBRYO: For the Bulletin, “the term applied from the time of implantation until the end of the eighth week, when organogenesis is widely performed.” In Terminology: “the term applied to the human fetus from the time of conception until organogenesis is largely completed (10 gestational weeks). Embryo is an embryological term and should not be used for statistical information purposes.”
FERTILIZED EGG: Bulletin: “the stage of development that goes from fertilization to implantation, at the end of approximately the first week.’ (The term does not appear in Terminology.)
GESTATION. The two versions coincide in affirming that the beginning of pregnancy is implantation.
EMBRYO: Bulletin and Terminology insist on their disdain for the period prior to implementation and leave the first days of development in limbo – The Bulletin until the ‘end of the eighth week’; for Terminology is the tenth gestational week.
FERTILIZED EGG: The Committee eliminated the only term that, according to the Bulletin, referred to the pre-implantation time, although Terminology retained ‘Zygote’, ‘Morula’ and ‘Blastocyst’.
No reasons are given for the changes and, contrary to what could be expected, the ACOG did not enthusiastically endorse the work of the Committee. Nor was it very well received among the translators or in scientific references. It seems legitimate to conclude that the authority of Terminology is not exclusively scientific, but social. It is a private, unofficial authority. It was the obstetricians themselves who disavowed the definition of conception as implantation.
II. The Catholic Raymond Holden and the introduction of the Resolution of 1937
The 1937 Resolution of the AMA on the position of doctors and contraception was a sort of blank check for the practice of contraception. Given this situation, the AMA created the Human Reproduction Committee (HRC). Among its members, those who had shown their support for the spread of contraceptive practices predominated, beginning with its president, Raymond T. Holden.
The HRC set out to study the methods of fertility control already in use. The study’s final result was a review article, approved by the Board of Directors of AMA and its Chamber of Delegates at the Miami Beach Clinical Convention in November 1964. The event was considered a milestone that marked the change of the AMA policy with respect to human reproduction and demography. The article, “The Control of Fertility,” defined the new principles accepted by the AMA: that the control of the population was also a matter of responsible medical practice; that the medical profession must assume a serious responsibility for human reproduction, which affects the entire population as well as the individual family; that doctors should give advice and guidance or refer patients to the appropriate people when asked; that WADA should take responsibility for disseminating information among physicians and by the most appropriate means on all stages of human reproduction, including sexual behavior.
A second task assigned to the HRC was the preparation of a teaching program that would serve as a guide for teaching medical students about human reproduction. The document was sent to the Medical Education Council of the AMA and to the deans and department heads of all medical schools in the United States. Given the silence of the recipients, no further decisions were made on this matter.
The publication The Control of Fertility ends the process of reception and dissemination by the AMA of contraceptive practices for physicians. But the HRC was criticized for its lack of objectivity, because its authors, concerned about highlighting the benefits of oral contraception, were silent regarding the adverse phenomena attributed to oral contraceptives, including circulatory and metabolic disorders. Holden himself acknowledged that there was not enough emphasis on the unwanted effects of the oral contraceptives, because in the HRC they considered that it was enough for the approval of the FDA to guarantee the safety of “the pill.”
The problem that affected many Catholic doctors (Kosmak, Rock, Hellegers) is repeated here once more: how to make compatible their Catholic faith, on the one hand, and their professional medical attitude favorable to contraception, on the other. Holden, though divorced and remarried, professed that he was Catholic. He could not ignore the doctrine of the Catholic Magisterium on contraception. In addition, the abortifacient effect of oral contraceptives could not be ignored. As President of the CRH he wished “to find methods that are acceptable in a human sense, and acceptable also to the various religious and ethnic groups.” It seems that Holden resolved the conflict between his two loyalties – his debt to the Catholic faith and its religious morality, on one hand, and his duty to his institutional and professional commitments, on the other – by establishing a complete separation between them. His religious commitments and professional commitments belonged to two separate worlds, independent of each other. With this, the conflict ceased to exist.
FROM THE ORIGINS OF CONTRACEPTION TO HUMANAE VITAE: SUPPRESSED STORIES
Author: Gonzalo Herranz, University of Navarra. Email: [email protected]
The full chapter upon which this summary is based is available in Spanish only. Click here…