Journal Club Review – The 14 Day Rule

May’s journal club was lead by Caitlin Warlick-Short (Graduate Student in Timothy Gomez’s lab). Journal club review was written by Grant Hisao (Postdoc in Katie Henzler-Wildman’s Lab).

Pregnancy termination is a highly contentious social issue that has been in our political discourse for over forty years. With each election and legislative cycle, the issue continues to make headlines, including recent legislation such as Iowa’s heartbeat bill as well President Trump’s recent announcement of new abortion restrictions. A related, yet distinct, issue surrounds research done on embryos and embryonic stem cells. Though there may be controversy of the ethics of stem cell research, fortunately, policy has been enacted for over 20 years to maintain an ethical level of scientific research on embryos. This policy colloquially known as the “14 day rule,” and was the topic of discussion at CaSP’s science policy journal club for the month of May.

What is the 14 Day Rule?

In 1979, the US Department of Health, Education, and Welfare’s Ethics Advisory Board published a report titled “HEW Support of Research Involving Human In Vitro Fertilization and Embryo Transfer.” This study, which revolved around the ethics of in vitro fertilization, was started just only months before the first infant conceived through in vitro fertilization was born (article on Louise Brown). As part of the report, the board recognized that fourteen days typically signals the point by which naturally conceived embryos are implanted in a woman’s uterus. Since about 25% of all naturally conceived embryos fail to implant and are lost by this time, the board found it ethically acceptable for research to be conducted on human embryos up to this point.

In 1984, the United Kingdom was the first country in the world to adopt the rules and in 1994, the United States adopted the same regulation. Since its proposal, 12 countries have encoded the 14 day rule within their laws (e.g. UK, Canada, Sweden, etc.) and 5 countries (e.g. US, Japan, China, etc.) have scientific guidelines. Furthermore, the 14 day rule was also a part of the 2016 guidelines from the International Society for Stem Cell Research.

How does the 14 day rule relate to abortion?

The 14 day rule has for the most part been considered a successful policy because it places a reasonable limitation of research while appeasing people with socially conservative views. However, in the primary article discussed at our journal club (article can be found here), the author argues that recent developments in embryo research may eventually lead us to a point where any form of abortion may be abolished.

As summarized in the article, embryos fertilized in vitro in the past had not been viable beyond nine days. However, in 2016, two independent research groups (first paper; second paper) published studies that demonstrated in vitro viability for 12 to 13 days, pushing the envelope of scientific advancement. Furthermore, other advancements such as growing a lamb in an artificial womb, have been conducted, which entertains the possibility that one day we will be capable of growing and producing a healthy human in vitro.

Supposing that such advancements may happen, one must consider the question of viability within the context of our current interpretation of our abortion laws. In the ruling of Roe v. Wade, the courts defined when a woman could choose to have an abortion along the timeline of a pregnancy (abortion possible during first trimester, certain exceptions during second trimester, and no abortion possible during third trimester). Planned Parenthood v. Casey (1992) redefined the limit to the point where a fetus is determined to be viable independent of its mother. Thus, the author argues that if it is scientifically and medically possible to conceive and grow a baby in vitro, then any pregnancy (wanted or unwanted) will be considered viable and thus eliminating a woman’s right to choose.

Though no one present for our discussion was an expert on human embryos, we all seemed to believe that we are still a long ways away from artificial wombs. There still remains a lot unknown about the stages of pregnancy and fetal development to properly regulate a baby’s development in vitro.

A life is a life is a life?

As with many discussions about abortion, the conversation turned to the question of “pro-life” v. “pro-birth.” Although there are many utilitarian reasons for allowing pregnancy termination (e.g. mother’s health, economic impacts, foster care, etc.), there are many people who believe that any life is a life that needs to be preserved. The practical solution in preventing abortion is preventing an unwanted pregnancy from happening in the first place. This can be done by proper education and providing easy access to contraceptives. What complicates this is that many people who have an anti-abortion mentality also believe in abstinence only education.

The end of our discussion leaves us with no other practical solution to this problem. If a person believes that a life is a life is a life, how does one engage in a productive dialogue with such a person? Without any answers, one thing seems certain and that is that this controversy will continue to remain with us for many years down the line.