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you're much i'm gonna try to speed up my top so you don't get a too much of a delay um
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when we uh working together to discuss the topic of of
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this year's meeting challenges incarnate menacing i said well
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i i have a lot of talk that i gave a year ago to the national ethics committee
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that might sort of fit into into this uh conference and you know was accepted and
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i thank you for giving me the opportunity to percent short version of the top
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but i gave a year ago so it's about the beginning of life
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it's a very imprecise question really and i'm gonna try to give any and it all just
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to you um maybe have several views on different aspects it's a very personal view
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um we have heard today a lot of fascinating things that can be done
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um a lot of enthusiasm about what has become possible and i'm gonna
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try to just simply asked the question of whether to be really
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want all of this or do we sometimes mean over ourselves into
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situations um that we afterwards regrets that we have moved into
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so this is what i'm gonna try to present and i will discuss what is really
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the relevance of the question but does it come from i want to give you
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a brief personal background because need to understand uh why i say some of the
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things that i say i probably would have said these things ten years ago
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um i will then present different perspectives on uh the question of when does life begin
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and the very important um thoughts about life versus person who'd because
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i i think it is very much into this discussion
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and then to show you some of my um will critical faults
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i'm gonna tell you a a story and i'll leave
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it up to you to decide whether this is fact or fiction uh it's a story about a remarkable pregnancy
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and i will highlight some of the ethical dimensions and then finally leave you with some
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um comments uh i will not be able to give you the answer the question by the way
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uh and i want you to again uh take a global perspective on what we're doing
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so if you go into the um internet and you type in the beginning of life
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your bombarded with pictures about a right to life about
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termination of pregnancy this is what really dominates ah the topic in the internet
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and um there's an article published uh into town eleven by professor
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because she is the uh head of the national ethics committee
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and it's it's a very nice description of how how these uh things of beauty in in different uh
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you know professions really um but it's quite clear that there are people who
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um propose that there's a right to life and there is that people who propose that there is a right to abortion
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i think medical progress increasingly challenges various definitions and aspects of
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what we might consider to be the beginning of life
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and as i pointed out already i think um medical progress should
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sometimes ask whether you know what can be done little
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bow any babies and so let's just do it or whether or not everything that can be done should be done
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i i think the the the question you know when does life begin foreign unit colleges
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is is not really relevant i mean most of the times we are
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confronted with the patient that that is alive none of us has
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any doubts that if the baby is breathing as a heart rate
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this patient is alive uh regardless of what just station wages
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and we are more inclined to ask the question what is it now in the best interest of this patient
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um my personal background really just very briefly um i was trained in
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lucerne and then in the united states in units our g. rapid
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yeah fix first minutes all g. and uh pediatrics critical care
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and when i was at the mayo clinic i was first confronted with this a quote by billy mail
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yeah that's is that the best interest of the patient is the only interest to be considered
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and i find this maybe a bit simplistic but it it sometimes
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helps you know if you're in the midst of a discussion
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to to to try to reflect on is is this what we're trying to figure out really a question
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about is this in the best interest of the patient or not and and it will be helpful
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um huh in two thousand twelve i started to travel like a marcus as already mentioned uh to several
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african countries um ivory coast out the damn yeah maybe
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yeah and i was confronted with very different environments
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i very much became aware of how privileged we are and i think we should
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be very careful with um you know how we deal with these privileges
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uh in fact is starting much earlier um in nineteen
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eighty six just after graduating from medical school
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i spent a year in what was a former how land of south africa called the republican puppets wanna
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and i'm sure a little sequence of what you know work look like as a medical officer
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this video is a sort of a scary to me for two reasons first um this is me
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um and and the second reason is that i've come to realise that not much
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has changed in these countries as far as medical possibilities are are concerned
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so um this is my professional background and this was something that i
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think you should keep in mind when i when i continue
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so you know living organisms can be just fine by
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biological properties you remember that probably for medical school
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i'm living organisms can grow and develop they can reproduce they have
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uh the ability to to the inherit uh properties they
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and maintain harmless stacy is they have a travel isn't they have a cellular structure and
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organisation and they're able to response to stimuli so this is this is life
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um excel is an x. l. alive yes of course it has these properties
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are spawns alive uh it looks like they are ah um so
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that's not what we're really talking about um we're also not
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talking about the philly genetic perspective landed life begin onerous
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knows scientists tell me that this has happened a very long time ago i see as you can see
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and they speculate of how this came uh about and they say there were some
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a certain conditions that favoured the synthesis of
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organic compounds from simple inorganic precursors
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and there is a a an important experiment uh in
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that type of research which is called ameliorate experiment
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who sort of imitated the conditions on primitive or of and
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were able to show that in fact yes it's true
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you can synthesise um complex organic compounds from inorganic precursors
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now the on to genetic perspective is is probably what we are
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mostly dealing with um focuses on the development of an individual
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you know how does an organism developed from effortlessly excel
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and the term beginning of life if i'll is often used in
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this context even though even here there is a continuity
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of life throughout generations and the process really stripes the development
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of an individual rather than the first emergence of life
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but it does offer the opportunity to define the beginning and end of an individual life
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and you know very often when there is sexual reproduction the fusion of too
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damn it's is regarded as the beginning of the life of an individual
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but that clearly is not on disputed
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so when does life begin you know this to begin with effortless
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the egg or does it begin when the baby is born
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people have different opinions on when this happens and it it covers this entire spectrum so
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some people say yes individual life begins with the formalisation of an x. l.
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others say no it has something to do with the ability
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to perceive so with um c. n. s. development
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others in the past in particular say no life really begins then
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when mom is feeling the first time that her baby is kicking her just call quickening
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and another say no and we've also sort of for some ideas in in this respect
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is no it's really when the baby is able to survive x. you true
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but what do you mean by that on and so on or uh with
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all the technology that we have available so it's it's not clear
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so is this life is this the beginning of an individual
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life or is this the beginning of an individual live
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well if it's per of um then is it when the baby is completely delivered
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or is it when we cut the cord
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or is it when the baby takes it's first breath
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well if we would argue that life begins when a baby is born
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separated from its long then what exactly are features surgeons doing
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oh they operating on something that's not alive when they repair like we heard
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this morning my own mean men in conceals or divert massacring yes
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or what exactly what we mean by in for you train
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resuscitation you can only resuscitate something that has been alive
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so clearly um but back definition would not holes but
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uh no i'm just gonna redo in german what michael to be an american philosopher said
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it's quite some time ago i have to admit in the late eighties he said
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so big these labels actually eight million elated reason to begin up
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when when shopping to conduct for to be faulty sheldon imperial
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and fruit and annoy get warm a niche from bigger if
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the persona forced so he uses the term person who'd
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scott hilbert uh a developmental by all just says um something that i think
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is is is close to what what i can understand and and follow
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that the entity created by for playstation is indeed a human embryo and it has the potential to become human adult
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whether these facts are enough to accorded person who it is a
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question influenced by opinion philosophy and theology rather than they signs
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now does this have any any impact on what we do and how we do what we do yes yes it does
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and you can go back in history to r. s. to tell 'em in the on the
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market described difference so alls i know is that there's a new touch of soul
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and the two two souls you can find with plants with animals and with human beings
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there's a sensitive soul which plans do not have only animals and humans have
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and there is an mind or rational soul which is unique to human beings
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and this may seem quite old fashioned but in fact we need behave as if
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we also believe that there is something like successive in zone and other features
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assay grows older he has a higher value
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as a person because this finds entry into our well you seen this text before
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you know this is about later termination of pregnancy and areas shop will say the lapel second what channel ten
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you guessed the meat on the strong of how to define actually are we couldn't couple hinge eighty going
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well actually i don't see asian nude locking up given that you want and that's sort of the progressive insolvent
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to give our muscles averse assign the fort actually it's not the chunks of text
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so let me continue with my story is about a thirty five year old woman
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who has a congenital absence of her vagina and uterus and she desires to have children
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so from other agrees to donate her uterus and uh you just transplantation is performed
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um she gets her first menstrual bleeding forty three days after post transplant and please remember what i said initially
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you figure out for yourself which part of the story which is not a real story um
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what sort of a combination of different stories are true or facts and which are fictions
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she then gets pregnant one year after having received her uterus transplants
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by interests item that's magic sperm injection and andrew transfer
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and she becomes pregnant three weeks later a pregnancy test is positive and ultrasound shows triplets
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so obviously this is a high risk pregnancy and it is decided to enhance the chances of
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successful pregnancy completion to reduce this pregnancy to a
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twin pregnancy by multi futile pregnancy reduction
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well unfortunately features side is complicated by rupture of membranes
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intro you try futile demise of one of the remaining two feet to say is
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and six weeks later at twenty one weeks of
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gestation to develop cinematic infection syndrome with detective
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cardio and just decided to deliver this speeches and connect the features to an artificial placenta
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this is the images from a publication from two thousand
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and seventeen which shows that this is feasible
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it shows a a feat land connected to an artificial placenta
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it's a problem free system so the plot is only being pumped through the circuit by that teaches his own heart
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and the researchers were able to show that this lamb is growing and developing
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also after autopsy showing that the brain is developing apparently normally
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this is how these features lives in a bad filled with
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fluid connected through the umbilical vessels with an artificial percent
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so this vehicle x. m. o. is then unfortunately complicated by
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kept associated bloodstream infections jumbo says of the umbilical vessels
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and so uh this leads to emergency t. calculation at twenty three weeks and four days
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babies integrated the fact is it minutes to a uniquely
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intensive care begins with high frequency oscillatory ventilation
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cardiovascular support french attrition everything that you know well from your daily business
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and then finally after four months of cost playstation this baby
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is being discharged has this list of diagnoses some
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moderate p. p. d. a particular hemorrhage grade three left to right
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some but not with the excuse me of printed directly and so on
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so is this fact or fiction is this something that is not yet possible about
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will be possible in the new feet near future well some people believe so
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and some people in switzerland believe that this is feasible
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um as you can see from this uh article in in a in a swiss newspaper
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but you know for myself i wonder should everything we don't that can be done or is the country true
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you know this citation by a good to have the notice goals usually if the guy's of that vision initials
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so my final comments i don't know when life begins i think it's the wrong question actually
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uh i think that this uh
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quote by scott hilbert uh is is correct
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and i think in unit elegy it's not a question of when life begins um it's
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much more a question of what is in the best interest of the patients
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and um i i understand that can be a conflict
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of interests you know there's this conflict of a
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right to life but also this conflict oral this this uh counterpart which is the rights to abortion
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i think medical progress has reached an amazing levels and i was fascinated by the tops
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that were given today but i'm also a little bit concerned about what we're doing
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and i i think we have a global problem that we
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cannot just simply ignore you know if you look at
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this gap between high income and low and middle income countries it's enormous
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and that we do certain things in the face of such gaps
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uh on a global level is in my mind highly questionable
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so if we choose things like described in
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this fictional story or partly factual story
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and at the same time we know that uh things like this happen
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um then i do it makes that i have um several question marks
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if we know that under five mortality is so despair worldwide
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and half of the babysit died before the five years all tied in the neonatal period so it's really our topic
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so when we know that there is another eleven fold difference between
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switzerland and maybe a or twenty two fold difference between switzerland
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and the ivory coast then i think we can not just simply ignore that i do believe that
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the best interest of the patients the only interest to be considered and
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this is true for switzerland but it's also true for africa
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and with this i thank you very much for intention ah
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thank you very much so mostly showing these thoughts with us
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or to some comments or questions from the audience
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uh_huh saddam as you said um ten years ago you would have made enough to talk today and now we
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you looking only now decide how much is what what's that use the chest since then for us now
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we when we are going further on that will be but you do difference kind of election
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well i i think that we should first we should it's simply be
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a pretty shitty tip of what we should we should relies
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uh how really unlimited our resources or and then we should try to
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think about whether we really want to invest all our resources
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in what sometimes very marginally improves outcome of individuals and we
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should think about how we perhaps could um you know
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translate some of our knowledge into into a methods that can help improve situations or what
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and and i mean i i really knew this before but i think my
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my recent experiences just have sort of a really shaken me and
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that's why i say what i say that that's also i talked about my background you know i
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was as a as a younger person and maybe this is also sign of old age
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um i was absolutely fascinated what by what is is technically feasible
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uh and now i i think that uh you know sometimes it
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would be better not to do things that be technically candid
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oh absolutely i absolutely agree with you you um the matter it's to me or not
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can we do everything should be do everything what is in the interest of the patients or in the parents interest
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but how do we get our knowledge and or money or resources trains perch
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what the parts of the world with the same patients you present it would probably cost talk
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a million dollars i guess we could save i'll be a patients in africa least
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what is the best way to get the trains for all the money because but well i'm always talk you know we have
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well that's of money but we don't get it where it belongs to well i i i don't think i can give you this answer like in two minutes
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um but i don't think that just because we have failed in many
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instances to do that we should stop trying to do it
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um and and i think some of the interventions that we have proven
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in our world that are highly effective cost very little money
00:22:00
and i can tell you about this if you want me to but i think we need to to
00:22:05
finish this uh session and we have still some

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Conference program

Welcome words
Matthias ROTH-KLEINER and Philipp MEYER, resp. Lausanne and Aarau
22 Jan. 2019 · 9:34 a.m.
Welcome words
Markus Hodel, Lucerne
22 Jan. 2019 · 9:39 a.m.
Short report - Outcome of very preterm infants
Philip Thwaites, Zürich
22 Jan. 2019 · 9:42 a.m.
Short report - Bronchopulmonary dysplasia (BPD)
Ikbel El Faleh, Lausanne
22 Jan. 2019 · 9:50 a.m.
Non-invasive prenatal diagnosis
Siv Fokstuen, Geneva
22 Jan. 2019 · 10:36 a.m.
Fetal diagnosis and therapy (part 1)
David Baud, Lausanne
22 Jan. 2019 · 11:33 a.m.
Fetal diagnosis and therapy (part 2)
Nicole Ochsenbein-Kölble, Zurich
22 Jan. 2019 · 11:51 a.m.
Minimal invasive therapy of congenital malformations
S. Holland-Cunz, Basel
22 Jan. 2019 · 12:03 p.m.
Discussion
22 Jan. 2019 · 12:26 p.m.
Management of PPROM around 34 weeks (part 1)
R. Pfister, Geneva
22 Jan. 2019 · 2:48 p.m.
Management of PPROM around 34 weeks (part 2)
B. Martinez de Tejada, Geneva
22 Jan. 2019 · 3:06 p.m.
Late termination of pregnancy : legal, ethical and medical aspects
R. Favre, Strasbourg (France)
22 Jan. 2019 · 3:58 p.m.
The beginning of life
T. Berger, Lucerne
22 Jan. 2019 · 4:40 p.m.
Awards and Closing words
22 Jan. 2019 · 5:04 p.m.