Department of Mental Health and Sensory Organs (NESMOS), Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
, ASL Rome 1, Rome, Italy.
BMC Med Ethics. 2021 May 12;22(1):57. doi: 10.1186/s12910-021-00624-4.
Definition and concept of the 'beginning of human life' are weakened by co-existing contrasting hypotheses based on humanistic or religious beliefs rather than scientific foundations. This plethora of conceptually distant views have important common concerns in different fields of science and shape, in turn, several societal aspects including laws related, for instance, to inheritance eligibility or abortion, end-of-life care and euthanasia, and reproductive technology. Also, they are fundamental to evaluate opportunity for resuscitation vs. palliative care in extremely preterm infants. In this article, we address one of the most common tenets in medicine: the acceptance that human life starts with first breath, even though several events are well-documented to take place before its occurrence.
Several studies show how pivotal physiological events take place before first breath. Evidence of a number of neurological events occurring before first breath opens the way to the primacy of the Central Nervous System, given its immediate extra-uterine activation at birth. This activation eventually sets specific physiological conditions that allow the complex sequence of events determining the muscle activity associated with the influx of air in the lung and the settling of a continuous and successful extra-uterine respiration. We would like to invite the scientific community to endorse a clear-cut position against the paradigm of 'first breath' as the beginning of life. Herein, we also assume how, a still undefined, yet possibly specific quid in the external environment triggers further physiological response in newborns. Better understanding of the critical events that occur at the beginning of human life is likely to cause great concern and expectations in scientists, researchers and physicians working in the domain of brain, and its physiology, and mental health.
The comparison between beliefs and evidence-based observations generates confusion, misperceptions and false expectations in society, hence, in the scientific and medical community. Different and more solid alternatives about the carachterization of the 'beginning of human life' are indeed available and require to be explored and defined.
“人类生命的起点”的定义和概念因基于人文主义或宗教信仰而非科学基础的相互矛盾的假说而变得模糊。这些概念上截然不同的观点在科学的不同领域中有许多共同的关注点，并反过来影响了包括与继承资格或堕胎、临终关怀和安乐死以及生殖技术等相关的法律在内的几个社会方面。此外，它们对于评估极度早产儿复苏与姑息治疗的机会至关重要。在本文中，我们将探讨医学中最常见的一个原则：即接受人类生命始于第一次呼吸，尽管有许多事件发生在第一次呼吸之前。
多项研究表明，许多生理事件在第一次呼吸之前就已经发生。一些在第一次呼吸之前发生的神经事件的证据为中枢神经系统的首要地位开辟了道路，因为它在出生时立即在子宫外激活。这种激活最终设定了特定的生理条件，允许与空气流入肺部和连续成功的子宫外呼吸相关的肌肉活动的复杂序列决定事件发生。我们想邀请科学界对将“第一次呼吸”作为生命开始的范式表示明确反对。在此，我们还假设，外部环境中尚未定义但可能特定的刺激因素如何引发新生儿进一步的生理反应。对人类生命开始时发生的关键事件的更好理解可能会引起从事大脑及其生理学和心理健康领域的科学家、研究人员和医生的极大关注和期望。
信念与基于证据的观察之间的比较在社会中产生了混淆、误解和错误的期望，因此也在科学界和医学界产生了混淆、误解和错误的期望。关于“人类生命起点”特征的不同且更可靠的替代方案确实存在，需要加以探索和定义。
