Birth Control

The technical possibilities of modern medicine raise ethical issues that can be overwhelming. Despite having long pushed for action, we realize that it is no longer accompanied by a clear judgment. An article on birth, death and autonomous choice.

Birth and death, the events that mark the limits of our life, have always concerned human beings. But the absolute autonomy of choice demanded by our times has given the interface with birth and death a new, completely unprecedented, dimension.

Welcome to earth - a great gift.

A third of Caesarean births

While the prolongation of life and assisted suicide have been regarded for decades as serious and complex issues, the question of life after death – now arising in an increasingly arbitrary way through the determination of pregnancy and childbirth – is a much less often discussed topic. Not to mention the possibility of life before birth. We overlook the fact that in Switzerland the date of birth in a majority of cases is already determined from outside. The number of Caesarean sections by regulations has risen in Switzerland to 33%, double the maximum recommended by the WHO. Studies made in Germany show that only 10% of Caesarean births take place on medical advice.

Where are the limits?

The media report enthusiastically new conquests in medical techniques: pregnancies from successful uterus transplants, pre-implantation diagnosis, prenatal laboratory tests by simple blood tests of pregnant women for early detection of Downs syndrome. Meanwhile, economic pressure is increasing. Neo-natal services in Germany receive more money for the treatment of premature infants weighing less than 1500 grammes but must achieve a ‘minimum’. So suddenly the number of premature births under 1,500 grammes is rising. We are used to this kind of headlines but do we really understand what they mean? Even if it is only for ourselves, how can we build sound judgment?

Prenatal experiences

While there is a veritable flood of scientific publications on near-death experiences, published reports concerning birth are still rare. In 2014, among school children to whom they had asked very pointed but validated questions, two Boston University psychologists found there was still the feeling of having existed before birth. For most of those interviewed, it was clear they did not exist biologically before conception, but they already had feelings and desires, such as when the mother actually became pregnant, the moment of making her acquaintance.

These complex investigations were deliberately conducted in two totally different cultural backgrounds in Ecuador, but the results were surprisingly similar in both groups. The authors write in their summary: "The results are consistent with research on near-death and suggest that there is an unschooled cognitive tendency according to which emotions and desires are linked to the eternal core of the personality." Is it not remarkable that modern psychology, based on rigorous scientific research, can now evidence an "eternal core of the personality"?

Ethics in question

Western civilization is founded on the inviolable dignity of the individual, guaranteed in the Universal Declaration of Human Rights (1948), the European Convention on Human Rights (1950, Switzerland's accession in 1974) and the Swiss Civil Code (1907). There remains, however, a utilitarian thinking that asks under what conditions is the individual ‘useful’ to society as a whole? These considerations often appear in the guise of rigorous science, but in the past have led to the most appalling aberrations. They will challenge us again soon. Medicine opens up increasingly grandiose technical possibilities, at the same time resources are becoming scarcer. The fear that the (technical) possibility of (oneself) determining birth and death lead to widespread social pressures. Parents of children with Downs syndrome, for example, are made to feel that "basically, you could have prevented this."

The human being, a citizen of two worlds

How can we forge a judgement on all the issues related to birth and death? Is it not better to leave them to medical specialists and ethics committees? No! Many of today’s ethical assumptions are based on a unilateral thinking steeped in a materialism that does not take into account all aspects of life. Birth and death – events that mark the boundaries of our lives – raise the question of a reality existing beyond these borders. While birth and death are also clearly physical events, they show that the human being is a citizen of two worlds. And since we put so much emphasis on our independence today, the question arises as to the identity of this autonomous self.

The prospect of life before birth and after death – if only as a possibility – should caution us before thinking of determining birth and death only from the perspective of the earthly existence familiar to us. This is what many people feel, and they act accordingly. It is remarkable that in Switzerland, despite all the prenatal diagnosis, the number of children with Downs syndrome has doubled in the last ten years! What does that tell us?

Dr Hans-Ulrich Albonico

Giovanni Maio: Medizin ohne Mass? Vom Diktat des Machbaren zu einer Ethik der Besonnenheit. TRIAS, 2014. (‘Medicine without measure? From dictation of what is possible to an ethic of prudence.’)
Rudolf Steiner: Richtkräfte im Chaos. Wie kann die seelische Not der Gegenwart überwunden werden? Rudolf Steiner Verlag, 2004. (‘Ordering chaos. How can the psychological suffering of the present be overcome?’)
Peter Selg: Ungeborenheit. Die Präexistenz des Menschen und der Weg zur Geburt.

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Glossary and Legal Position
‘Birth Control’ is based on measures to prevent or offset, as well as promote it.

Birth control measures
Contraception has long been fully accepted in Western civilization. The discovery of fertile periods in women (1930), the invention of the pill (1960), and later the IUD, as also their marketing, allow women to control their own fertility.

Through its legalization in the 1970s, abortion has also become a mark of our civilization. With 72.2% in favour in 2002 following thirty years of political debate in Switzerland, the revision of the Penal Code fixed the following time periods: during the first twelve weeks, the decision belongs to the pregnant woman, from the thirteenth week, termination of pregnancy is still permitted if there is a risk of serious physical or mental distress (Art. 118-120 of the Penal Code).

 (examination of the amniotic fluid): a puncture is made in the amniotic sac of a pregnant woman, in order to examine foetal cells, especially for the detection of chromosomal abnormalities, hereditary diseases (Downs syndrome), and metabolic diseases. Examination is permitted by law.

Prenatal testing 
NIPT (‘Non-invasive prenatal test’): A laboratory test that enables foetal DNA to be characterised by a simple blood test of the mother. It is used for early detection of chromosomal abnormalities, for example Downs syndrome in foetuses. Authorized by law.

PGD ​​Pre-implantation diagnosis: 
cellular biology or molecular genetic testing to determine whether an embryo created by IVF (see below) is allowed to be implanted in the uterus. Banned in Switzerland by the Assisted Reproduction Law of 18.12.1998, but now permitted by a large majority by popular vote in June 2015. Note: The law on medically assisted procreation is in the same Article 119 of the Constitution which deals with genetic engineering.

Measures to support procreation
Surrogate pregnancies: a surrogate mother is a woman who "lends" her uterus for the duration of the pregnancy, to give birth to a child instead of another woman. At the beginning of 2015 still banned in Switzerland by the Assisted Reproduction Law.

In vitro fertilization (IVF): 
an artificial fertilization method. The eggs are placed in a glass test tube with the treated sperm, in the hope that spontaneous fertilisation will occur. It optionally produces a spontaneous fertilization. The embryos are cultivated in an incubator, subject to ‘quality control’ and then placed by embryo transfer into the uterus. Authorized by law in Switzerland.