The horrors of embryology?

[taj]

Salam,

When looking at the Embryonic Disk in a CAL session, my curiosity as to how scientists have acquired all of the embryology that they teach us whelmed me and I sent an email to a lecturer who shall remain anonymous. My question included: "I am a first year UCL medic who like to ask the following: what research techniques did scientist use over the past decades ...".

The answer included:
"... Have a look at www.wolframscience.com/reference/notes/1010a ...
... This was originally based on detailed studies of microscope sections of human embryos and fetuses found by pathologists in the uteri of women who died of unrelated causes, and in uteri removed at hysterectomy from women who (before pregnancy tests) did not know that they were pregnant (of course, in these cases, embryonic ages are uncertain). Much of the experimental stuff about tissue interactions and genes is based on research on chick embryos, subsequently extended and confirmed by tissue-culture of early mammlian embryos and embryonic organs from later embryos.

Human embryos can be observed directly up to blastocyst stages."

What terrifies me in particular is: "and in uteri removed at hysterectomy from women". Does this mean that embryos were accidentally slaughtered during such hysterectomies and their corpses were thence used for research? IS THIS ACCEPTABLE?!

Henceforth, I am now far too scared to answer any embryology questions, but realise that my fresher's mind may have misinterpreted the information and drawn erroneous conclusions. Hence, I ask you, my beloved elders, and anybody else of sincerity, to advise me with respect to this.


Wassalam



--
Insha’Allah

[Sajjad]

AA,

If you were reffering to original methods of studying embryology - as in early 1900s and pre 20th century then yeah specimen acquistion does come about through dodgy means such as post hysterectomy. Pretty much anything was acceptable in medical research back then...even gravedigging.

I did my last second year SSM in "Understanding Abortion" and an embryologist explained how they acquire specimens nowadays - most of the time they acquire them post termination/miscarriage and do something called Carnegie staging which asseses which stage they are at in development and therefore allowing their age to be estimated. However these are obviously dead foetuses/embryos and therefore aren't much use in ellucidating dynamic events and the functions of certain genes etc.

As for your original question of how scientsits deduced all this, well its really a combination of preparing live embryos either in vitro or in vivo and doing things like knocking out certain genes or inhibiting certain receptors or using various methods to see which proteins interact with other proteins and so on. For example, knocking out a certain gene may lead to a malformation in the formation of a blastocyst, they can then run through further experiments to see what the gene product interacts with and other people will take their work on further and slowly over time a general picture can be built up about what proteins are required for blastocyst formation and how they achieve this and how they interact with one another.

I'm glad someone is actually showing some interest in embryology - I'm glad I'm not the only one lol.

Ws,

Saj

[Shayan]

Salaam.

Thank you Taj for raising so many interesting questions, I will attempt to suggest some possible answers for you to consider.

To quote what you asked (if I am correct this is your main concern):

"What terrifies me in particular is: "and in uteri removed at hysterectomy from women". Does this mean that embryos were accidentally slaughtered during such hysterectomies and their corpses were thence used for research? IS THIS ACCEPTABLE?!"


Firstly, one thing to consider with respect to the "embryo's removed in uteri from women during hysterectomy" is when was this performed? i.e. how long ago. As Saj rightly mentioned medical science has in the past (1900s & pre-20th century) been responsible for the unethical procurement of samples/specimens in order to further medical research & understanding. Nowadays (and I assume this has been the case for many decades now) no fetus/embryo could be taken from a mother for research without INFORMED CONSENT.

There have been instances where this protocol has not been followed such as the case of the pathologist, Professor van Velzen, at Alder Hey Hospital who removed and retained children's organs at post-mortem examination without consent (if you search the BBC website you can get more details of this). The point I am raising is that in the past it is true that embryo's may have been removed for medical research either prior to it being known that these were present, or without the knowledge of the patients. I very much doubt that this is the case at present.

One further issue to consider here again relates to the timing of these experiments. Scanning/imaging in the 1900s/pre-20th century was not as advanced as the Ultrasound used these days and so it may have been the case that many women who underwent hysterectomies did so without either the doctors or they themselves being aware of pregnancies. Having said this, Ultrasound is clearly not the sole means to confirm pregnancy & neither is it routine (please correct me if I am wrong) to perform this before a hysterectomy. Urine tests would have been possible, but perhaps the clearest indication of a preganancy would be the obvious cessation of menstruation which one would think would have led both doctors & patients to query if a pregnancy had occurred.

The issue about whether in the instance that embryos were in utero & these were kept with/without the knowlege of the mothers after hysterectomy I am unable to say - only those involved would know!. Similarly, did the doctors know that these patients were pregnant and perform hysterectomies regardless in order to acquire embryos for research?, I think we are unable to answer. Though you would hope that anyone practising medicine, regardless of which era they practiced in, would not have such low moral standards.

One further issue to consider is the medical indication for the hysterectomies to be performed. As a third year student I have no knowledge of Obstetrics & Gynaecology, but I assume that where a woman is in medical need of a hysterectomy it is unlikely that she would have carried a fetus to full-term. Again, please do correct me if I am wrong. In this case it could be argued that the deaths of the embryos were unavoidable. Yet again, whether the fact an embryo was present in utero & kept for research was concealed from the woman I think only the medical professionals involved at the time could answer.

Your original question asked that if these embyros were accidentally killed & subsequently used for research, is this acceptable? This in itself is a huge ethical discussion and one would need to consider the question, acceptable to who? As mentioned above it may be possible that in the past it may have been acceptable to the doctors/scientists who may have carried this out. However, I think nowadays all doctors and scientists would unanimously agree that the procurement of embryos (or indeed any biological sample) from a patient without prior informed consent is not acceptable.

Islamically I would recommend you ask a scholar for the position on this, though I assume that retention & experimentation on embryos without the prior knowledge of the Mother would be considered unpermissable. To be honest I do not know the exact Islamic position on medical research on embryos in general & so I would recommend seeking the advice of an Islamic scholar (maybe search: http://www.sunnipath.com).

Lastly you mentioned you are reluctant to answer any embryology questions - my advice to you would be don't be! It is through questioning accepted knowledge/current & past beliefs alone that we are able to further our understanding and knowledge. If there are things you are unsure of, or disagree with then do question these & seek answers from reliable sources.

Whilst I admit I have not given any definitive answers to your query and perhaps have left you with more questions than you had before, I hope you will find this useful. If I have said anything incorrect then please do correct me.

Remember, Allah (swt) knows best.

Wasalaam,

Shayan

[Shayan]

AA,

Just something further I wanted to add for you to think about. If I am not mistaken Taj, you also asked in an earlier post (I think it may have been removed?) if it would be acceptable to learn knowledge that had been acquired through unethical research and/or experimentation?

Whilst I am not qualified to give you a definitive answer to this question I would think that there should be no Islamic objection to this. Our learning of medical knowledge whilst at medical school tends to be either of established medical facts or the current most up-to-date understanding of scientific phenomena. Whether this knowledge was discovered unethically once-upon-a-time I think would be inconsequential in terms whether we should learn it.

We as individuals are not responsible for the mistakes that other members of the scientific/medical community may have made in the past, ethically speaking, whilst researching and furthering our undertsanding of processes such as embryology. It is correct that research performed unethically as you described previously would likely be disproved of in Islam, but it does not change the knowledge that is acquired i.e. whilst the means of acquiring the knowledge may not have been correct the end result is the same as that if it had been. Science/research merely uncovers or explains some of the many miracles of Allah's (swt) creation.

Remember Allah (swt) and His Messenger Muhammad (pbuh) instruct all Muslims to pursue knowledge - not only of Islam but of all the sciences as well. Learning and undertsanding processes such as embrylogy would be included in this and our responsibility as Muslims is to acquire this knowledge but, where we are directly involved in the research that furthers our understanding we should make sure it is ethical and abides by the Islamic principles of research.

Lastly, my advice is to always make our intentions sincere & for the sake of Allah (swt), and to learn knowledge that will benefit us as individuals & this Ummah.

WS,

Shayan

[mrakhtar]

Salaam All,

First of all i'd like to thank Taj for asking such questions, because the vast majority usually either dont care, or are too afraid to ask. These issues need to be discussed, and if they don't go on in places such as the medical isoc forums, then where else right?

I have to say i agree with the majority of what Shayan has said, so not much point in me simply rephrasing what he has said.

'We as individuals are not responsible for the mistakes that other members of the scientific/medical community may have made in the past, ethically speaking, whilst researching and furthering our undertsanding of processes such as embryology. It is correct that research performed unethically as you described previously would likely be disproved of in Islam, but it does not change the knowledge that is acquired i.e. whilst the means of acquiring the knowledge may not have been correct the end result is the same as that if it had been. Science/research merely uncovers or explains some of the many miracles of Allah's (swt) creation.'

Shayan - once again a brilliant statement. Freshers + others - take advantage of this guy's wisdom while you can!

Taj - would like to hear your thoughts on all the discussion so far...

Wasalaam
Rashid

[NMA]

AA,

Interesting discussion- some good reponses. I would like to intorduce a few other thoughts:

If you know your embryology, you know your anatomy. And you can make more sense of gentic defects etc, in clinical practice. And paediatrics is easier. Embryology is worth learning.

Embryology is a science, part of which is described in the Quran. e.g. surah 23. Here is a link to an article hosted on Islam 101, but written by Keith Moore (who also, I think, wrote a good embryology textbook): www.islam101.com/science/embryo.html

Something that struck me from your post, Taj, was the whole slaughtering of embryos... that indicates killing them. But in order to be killed, you have to be alive. So my question for you is, at what stage in the embryological/ fetal development does life begin?

Finally, to clarify some of the clinical points raised- Yes, if a hysterectomy is required in modern medicine then an embryo would be increadibly unlikely to survive to full term in that uterus. Some of the more dubious indications for hysterectomy in the past (including psych. conditions!) probably were less life thrreatening, although that was the medical treatment of the time.

Ultrasound is not the best means of identifying pregnancy. The ultasound probes used during pregnancy are primarily to identify the fetal heartbeat. In terms of identifying pregnancy, the fetal heart sounds are late signs. It is true that ultrasound is also used to image the uterus, and the fallopian tubes in the case of a suspected ectopic pregnancy, but I think the small size of the embryo would make early positive diagnosis of pregnancy tricky. The simplest method of pregnancy testing is a urine test for beta-HCG, which is an accurate early marker of pregnancy (why? what is beta-HCG and when is it produced?).

The cessation of menstruation is not as reliable a sign as might be expected. Firstly because not all women are perfectly regular with their periods. For some, being off by a single day will be cause to consider pregnancy. For others, with more irregular timing, weeks can pass before suspicion is aroused. Menstruation is less regular proceeding menarche and preceeding menopause, so pregnancies in these time periods may be harder to spot.

Let us also consider when a hysterectomy may be required. Malignancy, analgesia and excessive blood loss spring to mind as modern day indications. I would hazard that excessive blood loss was also an indication in the past, along with some other perhaps less convincing reasons. If a lady is bleeding PV, then cessation of menstuation may be harder to guage. In patients with endometriosis, hysterectomies are a surgical cure for dysmenorrhea, and one that is seriously considered in those patients who have completed their families.

Hysterectomies were certainly more common say, 50 years ago than they are now, as we have better medicines and don't need to resort to surgical management as quickly. Of the hysterectomies performed, few would need to be housing pregnancies for a decent evidence pool to amount.

If any of the above is incorrect, please accept my apologies. It's been a few years since I did O&G. I recommmend the 'Ten Teachers' books for O&G, by the way.

wslm

NMA

[Sajjad]

At the risk of triggering a philosophical debate, NMA illustrated a good point: "at what stage in the embryological/ fetal development does life begin?". Biologically speaking the answer to this would be at the moment of inception i.e. the formation of the zygote - since this cell is "alive" and is able to perform various cellular processes. However we are unlikely to give as much rights to the zygote as we are to a fellow person. So the questions we should be asking is at what point does the embryo/foetus become a person (note the use of "person" and not "human") and why would or wouldn't we give the same rights to a zygote as any other person? This forms the crux of the abortion debate.

There are a few interesting philosophical standpoints on this I'd like to share.

If you're someone like Peter Singer (which I am inclined to think none of you are because this is an islamic forum!) you would argue that a zygote has very low intrinsic value and has the same value as another single cell entity such as an amoeba. To give a more pragmatic example, Mr. Singer does not see any difference in aborting a foetus and killing a lamb or a calf...and thats putting it mildly.

Obviously Mr. Singer does not take into account the potential to become a person. This argument however has been laboured in the abortion debate but an interesting and fresh argument has been put forward by a Catholic philosopher who argued that in fact a foetus or embryo IS a person with potential i.e. right from the point of inception the zygote is a person but has just not developed the faculties that me or you have. So instead of a potential person he is arguing that the foetus is a person with potential.

Lastly, I would like to point out the disparity of foetal rights between a foetus and a premature baby. When in the foetus say at 23 weeks the mother has the right to abort the foetus under certain grounds in the Abortion Act, 1967 and Human Fertilisation and Embryology Act, 1990 but say the mother went into premature labour, under UK legislation every effort must be employed to try and save the neonate's life? So whats so different about being in the uterus and being in the open world? Why should the baby have more rights when its born and less so as a foetus?

I leave you to ponder

Wslm,

saj

[taj]

Salam,

"Does this mean that embryos were accidentally slaughtered during such hysterectomies and their corpses were thence used for research?"

OK, I think I've calmed down by now, Alhamdullilah.

I want to say how awesome your replies have been. The depth, care and sheer speed of response is very comforting.

It's taking me a while to get used to the idea that medicine is halal after all (within the boundaries), so I apologize for any future panic and fury.

Insha'Allah (t) I'll learn to channel such emotions into something more constructive...

Thanks!

Jazakallah khairun,

Wassalam

--
Insha'Allah (t)