The recent decision for the Labour executive to change the amendment to the abortion act in the criminal code was a wise one, if not only because the amendment they had originally proposed went against the Maltese constitution.

As it is, the current law now only prescribes that, which doctors in Malta have always done. First to protect all human lives under their care including that of the mother and baby and secondly, if certain conditions are met, in situations beyond our control, to limit the damage done by saving one life rather than lose two. We did this under long established biomedical principles such as that of double effect and that of proportionality.

Although I agree with the amendment, I would rather have left the rule unwritten rather than put it into law because as the executive head himself said, this is just a beginning, a pretext for what is to come as the Maltese people may or may not change their opinion in the future. The fact is that our Constitution states that everybody has the right to life and that no human being who is innocent has to face the situation where this right is arbitrarily taken away under any pretext. The right to life of innocent human beings is absolute. Our Constitution specifically only allows the right to self-defence if there is the situation of a mal-intentioned aggressor. A human being in the womb can have no mal-intention. My body my right does not overrule the rights of other human beings in the womb which are not part of your body!

Often the retort of the man in the street and also those who should know better, to the statement that the first cell of the embryo after fertilisation is the first cell of the new human being and therefore of the organism of the species Homo sapiens, is that it is just a clump of cells. The human embryo therefore merits respect from others and the very protection of that life being of equal ethical merit with other stages of that same life during different phases of development.

This retort is really a shrugging off of the responsibilities that every member of society has to other human beings, bringing to negation Aristotle's golden rule of natural reason, "do unto others as one wishes to have done to him/herself". This should rationally merit the simple answer that we are all after all, just a clump of cells, even in the adult form!

This play on meanings of course boils down to a major distinction for those who study biology. For most who study life there always stands out a particular distinction. The difference between a cell and an organism. A culture of human skin cells grown on a medium, is a bunch of human skin cells. They do not constitute an organism like the human embryo does. A single cell amoeba, is a single cell as much as an organism, unlike the clump of human skin cells so what constitutes the difference between an organism and a cell?

The ultimate answer of course is freedom to develop and subsist as an individual. The cell which is not an organism always develops under control of the other cells of an organism and does not contain the individual freedom to grow, function and develop as an organism, showing the full various functions of its freedom and unity of substance. An organism is free to act and develop allowing itself to exhibit all the functions native to its substantial existence. In philosophy we call this an active potency. Cells which are also organisms, even a single cell like amoeba or a human embryo exhibit an active potency, while cells which are not organisms, only exhibit a potency which is passive and controlled by other cells and is not able to exhibit the functions that the whole organism needs for its independent survival. A clone of dividing skin cells, remains a bunch of skin cells even if it grows and divides (by mitosis). It never becomes a human organism exhibiting for example the functions of a kidney. It only has a passive potency

Since all the cells in a human organism contain the same DNA, what distinguishes those cells with an active potency from those with a passive potency? The simple answer is, Epigenetics!

There are various forms of epigenetics, which I cannot discuss here, but I will concentrate on one form only. Methylation. As cells develop, parts of its DNA which code for human proteins (genes), can be shut down and unexpressed, and others which were previously shut down can be switched on. Methylation is obtained by the addition or removal of CH ₃ or methyl groups to different genes. There can also be other groups but the process is still referred to as methylation. This process of methylation produces in the human embryo a differentiation of cells which eventually become our liver, skin, muscle and all different human cell types. All these have the same DNA but are methylated differently according to their required pattern of behaviour endowing them with a passive potency.

During the production of the sperm and ova, all methylation patterns are removed (Tabula Rasa) save from 156 'imprinted' genes from a total of 300,000 genes, these latter being necessary for the embryo's initial human development. This freedom from methylation, acquires for the new embryo formed after fertilisation the freedom from the parents' methylation patterns. Because the new embryo formed after fertilisation till the eight-cell stage, is free form methylation patterns, it allows the embryo to develop fully and freely as a totipotent organism with an active potency.

Only after the eight (8) cell stage, do methylation patterns begin to change the ability of each cell to act independently and actively and one can only consider them cells where they are apart from the rest of the cell mass which is the whole organism. Within the whole cell mass these cells can function as part of the whole organism, but separately, they are just cells (pluripotent by nature although they may even be reversed to the totipotency state by removing the methylation patterns). Skin cells are part of the human organism when stuck to (communicating with) a human organism, separately they are just cells.

So yes, the first cell of the human being, like the adult form of the human being, is also an organism with an active potency and therefore merits equal legal protection as do other human organisms.

Dr. Michael Asciak MD, M.Phil, PhD.