Memo To Joint Health Care Committee on the Legal Status of the Human Embryo in Massachusetts Date: To: From: October 30, 2001 Joint Committee on Health Care, Massachusetts General Court Daniel Avila, Associate Director of Policy & Research, Massachusetts Catholic Conference Re: Legal Aspects of Question Regarding Status of Human Zygotes and Embryos in Massachusetts This memorandum reviews relevant Massachusetts law regarding the legal status of human zygotes and embryos, taking into account the questions raised and assertions made by participants in the recent Special Oversight Hearings of the Joint Committee on Health Care Regarding Stem Cell Research and Human Cloning (Sept. 14 & Oct. 18, 2001). The Introduction to the Joint Committee’s Briefing Packet states that "[c]urrent law in Massachusetts does not restrict experimentation on human embryos", citing M.G.L. Chap. 112, § 12J. The fetal research statute is not the only relevant provision however. The legal inquiry must also consider Massachusetts laws governing homicide, wrongful death, wrongful injury and abortion, along with interpretive court decisions, in as much as these provisions and cases concern the identification and protection of human life. This memorandum will not supply an exhaustive account of all possibly applicable rules, but will highlight those laws and cases particularly relevant to destructive research on human zygotes and embryos. In light of current law, the General Court should presume that humans at the zygotic or embryonic stage and existing outside the womb qualify for legal protection. The burden should rest on the shoulders of those who favor destructive experimentation to prove that a "human life" or "human being" is not at risk. Who Does the Homicide Code Protect? Many of the hearing participants debated the terms by which to refer to human zygotes and embryos. This exercise is more than a free-floating philosophical debate over terminology and meaning; it touches on a crucial question that the Massachusetts jurisprudence on homicide has addressed, albeit incompletely and not always consistently. That is, who is protected by the homicide code? The law itself must frame the inquiry. According to an early Massachusetts case, "Homicide, of which murder is the highest and most criminal species, is of various degrees, according to the circumstances. The term, in its largest sense, is generic, embracing every mode by which the life of a man is taken by the act of another."[1] The Massachusetts General Court and the state courts define murder as "The killing of a human being, with malice aforethought."[2] Similarly, "[t]he crime of manslaughter imports the taking of human life by an act not justified in law, but without malice aforethought which is necessary to constitute murder."[3] Although the statute governing vehicular homicide refers to conduct that "causes the death of another person", the Massachusetts Supreme Judicial Court has ruled that "[i]n keeping with approved usage, and giving terms their ordinary meaning, the word ‘person’ is synonymous with the term ‘human being’".[4] As interesting as may be the philosophical debate witnessed during the Oversight Hearings over theoretical distinctions between the terms "person", "human life", or "human being", Massachusetts jurisprudence has settled the legal question in the Commonwealth. All of these terms, when used in Massachusetts statutes or common law rulings pertaining to homicide, are to refer to the same subject. The use of any one term is not to be construed as an attempt to make what the Supreme Judicial Court has considered "arbitrary" distinctions between persons, human lives, and human beings.[5] Thus, for example, "[b]y the use [in a homicide statute] of the term[] ‘person’ .. . . the Legislature has given no hint of a contemplated distinction between pre-born and born human beings."[6] Does a newly fertilized zygote and embryo, particularly ex utero, qualify as a subject of homicide protection? The General Court has already determined as a matter of public policy in the abortion context that a human child in utero is "the individual human life in existence and developing from fertilization until birth."[7] In this respect, Massachusetts joins twenty nine other states officially recognizing by statute, state convention resolution, or appellate court ruling that "fertilization" or "conception" initiates the life of a human being.[8] This legal and public consensus carries far greater weight in identifying whom should fall within the homicide code’s protection than any private religious or philosophical opinions to the contrary.[9] Because the General Court recognizes that the entity in existence and developing from fertilization is a "human life", logic and fairness dictate the inclusion of this human life within the homicide law’s protective scope. Indeed, at least eleven states expressly treat the destruction of human embryos outside the abortion context as homicide from the moment of conception.[10] Obviously, the United States Supreme Court has removed from the state homicide code’s protection certain abortions that destroy human beings in utero.[11] As a result, a mother’s decision that is carried out by a physician to abort a pregnancy, thereby taking an unborn child’s life,[12] must be classified as lawful homicide in Massachusetts.[13] Not surprisingly, the federal abortion jurisprudence has created some confusion in Massachusetts about whether and when the state may act to protect prenatal human beings both in and outside the womb in the nonabortion context. In 1981, the Supreme Judicial Court opined that "[a]t least prior to viability, we are constrained by Roe v. Wade . . . from imputing to the State any interest in protecting the fetus as a ‘third party.’"[14] However, in 1989, the United States Supreme Court upheld the right of states to determine as a matter of state policy "when life begins in a nonabortion context, a traditional state prerogative."[15] In a series of rulings, the Supreme Judicial Court has extended such protection to prenatal human beings from conception forward. In the already mentioned case of Commonwealth v. Cass, the Court determined that for common law purposes, "[a]n offspring of human parents cannot reasonably be considered to be other than a human being, and therefore a person, first within, and then in normal course outside, the womb."[16] Where "[m]edical science . . . may provide competent proof as to whether the fetus was alive at the time of the defendant’s conduct",[17] the "infliction of prenatal injuries resulting in the death of a viable fetus, before or after it is born, is homicide."[18] The Court has yet to address a case under the homicide laws involving the killing of a nonviable human being. However, the Court has considered the question of civil liability in such cases brought under tort law. In Torigian v. Watertown News Co., Inc., the Court allowed for wrongful death recovery for uterine injuries to a nonviable child when the child subsequently is born live but yet is unable to survive because of prematurity.[19] Thus, a nonviable human being must be counted as a "person" as that term is used in the wrongful death statute.[20] In Payton v. Abbott Labs, the Court ruled that "[i]f the tortious conduct and the legal causation of the harm can be satisfactorily established, there may be recovery for any injury at any time after conception."[21] While in Thilbert v. Milka the Court denied recovery for prenatal injuries to a nonviable child delivered stillborn, its explanation of the grounds for denial inform the debate over the legal status of nonviable humans at the zgyotic or embryonic stages. According to the Court, the wrongful death statute was designed to provide a separate cause of action only to persons capable of maintaining a "separate" or "independent existence".[22] Thus, "[t]here is recovery where a child is born alive, regardless of viability at the time of injury, because a ‘live person was presently suffering from the injuries’".[23] In light of this jurisprudence, important principles should apply to the determination of the legal status in Massachusetts of embryos ex utero. First, the concept of "person" must be broadly construed, embracing any "human being" or "human life". Second, living human beings capable of an "independent existence", regardless of ability to survive to term or maturity, are subjects of rights in Massachusetts. While the courts have not yet dealt with a homicide case involving a nonviable human being living an independent existence ex utero at the time of a deliberately caused fatal injury, Massachusetts precedent suggests that the death should be treated as homicide.[24] Third, science must play a role in determining whether the human subject was "alive" or a "living being" at the time of the injury. Yet, in a 2000 decision ignoring this jurisprudence, the Court held that embryos produced by in vitro fertilization could not be implanted in the mother’s womb over the objection of the father. In A.Z. v. B.Z., the Court used "the term ‘preembryo’ to refer to the four-to-eight cell stage of a developing fertilized egg", taking its lead from an ethics opinion of the American Society of Reproductive Medicine.[25] According to the Court, in the in vitro fertilization (IVF) process "[i]f [ex uterine] fertilization between any of the eggs and sperm occurs, preembryos are formed that are held in a petri dish for one or two days until a decision can be made as to which preembryos will be used immediately and which will be frozen by the clinic for later use. . . . By using one or more of these preembryos, it is possible that the wife could conceive [by implanting them]."[26] Any attempt by the mother to implant the "preembryos" without the father’s consent would constitute, in the Court’s estimation, "forced procreation" compelling "one donor to become a parent against his . . . will."[27] The Court thus treated "fertilization" and "conception" as dichotomous events. This dichotomy infers that the human entity created by ex uterine fertilization cannot move beyond a newly coined stage of being a "preembryo" (a coinage new to Massachusetts jurisprudence but largely abandoned elsewhere)[28] until the entity’s physical status of independent existence outside the womb ends by the conception of pregnancy, or implantation.[29] But this sets up a conundrum when matched against the foregoing precedent. Earlier cases dealing with nonviable human life required a showing of independent existence ex utero by a living being before legal protection attaches. Yet, the Court in A.Z. neglected to consider the newly fertilized human entity as an independently protectable human subject precisely because and so long as the entity is forced, by the failure of one parent to consent to implantation, to continue a separate existence outside the womb. As a result and without explanation, the Court failed to inquire as to whether, for purposes of Massachusetts common law, the newly created entities at stake in A.Z. were living human beings. In sum, the current status of Massachusetts law, with one troubling exception, favors the view that human life in existence outside the womb is subject to the homicide and wrongful death law’s protections, regardless of whether the human life is sufficiently mature as to survive to infancy. The independent existence of a living human being, not viability, is a critical legal requisite. Humans at the zygotic and embryonic stages of development qualify for legal protection; the burden to disprove their qualification should rest on the shoulders of those supporting destructive experimentation. Typically in life or death cases the party seeking authority to act in a manner that possibly involves the loss of human life bears the burden of proving that life is not threatened. As long as some credible evidence gives rise to the possibility that human life is at stake, then a presumption favoring that view should apply. Proof of absolute certainty or complete consensus among scientists or in society should not be demanded of those who argue that life will be threatened by embryonic stem cell research. Rather, if any evidence is to be "irrefutable", to use the term employed by Dr. Michael West during the October 19th hearing before this Joint Committee, it should be the evidence offered to prove that human life is not at stake. As long as the claim that from fertilization a living human being exists has some supporting evidence and is not completely refuted by countering evidence then, even in the midst of a legislator’s doubt as to the truth of either claim, the presumption in favor of life should prevail and experimentation on human embryos should be restricted. Even in the face of those who insist that according to their personal beliefs life is not at stake in embryonic stem cell research, a legislator can reasonably act contrary to that view. This common sense approach is based on the uncontroversial premise that the mistaken loss of life is a much greater evil to be avoided than the mistaken protection of non-life. While it is not this memorandum’s intent to rehearse all of the scientific testimony submitted to the Joint Committee, it may be helpful to examine what areas of disagreement should be considered relevant and to identify the general nature of the disagreements and quality of the evidence. Have the opponents of embryo-destroying research produced credible evidence to support their claim that human life is at stake? Have the research supporters refuted such evidence by completely disproving the possibility of human existence before 14 days? These questions cannot be resolved until there is at least some agreement about what either side must prove or disprove. Here the law in Massachusetts serves as a guide. In homicide and wrongful death cases involving the loss of prenatal human life, the state courts have recognized the need for the prosecution to present scientific evidence indicating that a "living being" was alive at the time the destructive act took place and existed independently outside the womb before dying. The state courts have not required evidence of long-term viability, and of the victim’s capacity to think, feel, or interact.[30] Thus assertions about these issues should be considered irrelevant to the question of an embryo’s legal status in Massachusetts.[31] So, in general, what are the relevant claims and counterclaims? Proponents of the view that fertilization marks the beginning of a human being’s life point to the unique genetic constitution and the integrated organic functioning of the new entity, biological qualities that exist from fertilization. Opponents of this view refer to the phenomena of twinning and to the related ability of zygotic and embryonic cells to shift their development from one function to another function within an embryo, and even to develop into separate embryos, a feature called "totipotency". The opponents thus claim that until an embryo’s cells become biologically fixed to one destiny, and until the possibility passes that one embryo will split into two or more separate embryos, the entity cannot be identified as an individual human being. Packed into this dispute are contrasting philosophical definitions of "being" and "individual" and differing moral interpretations of the biological data. It is beyond the objective of this memorandum to explore in any depth the nature of this dispute or to provide extensive biological and philosophical documentation. However, framing in only the most general of terms the case for identifying the entity created at fertilization as an individual human being can serve two purposes. It demonstrates the reasonableness of the case for using fertilization rather than some other point to mark a human being’s beginning and it provides a map indicating the questions and relevant evidence the legislature could pursue in an even more in-depth inquiry to substantiate (or disprove) this argument.[32] The argument responding to the "twinning" and "totipotency" objections proceeds as follows: 1. The organic integration and biological growth of the zygote and embryo demonstrate a unity such as to constitute "one" life in being that is separate from other lives and other objects in being. This is the classic understanding of "individual", a reasonable conceptualization that nonetheless differs from the alternative claim raised by supporters of embryo research that an individual is an entity that is physically indivisible, i.e., lacks the potential for dividing into two or more individuals. This alternative and more controversial claim fails to account for the occurrence of natural cloning (see below) and the apparent possibility of experimental cloning using adult stem cells. The fact that cells from an adult human being might be used to clone another human being cannot mean that the original adult fails to exist as an individual. 2. Any switching in functions within the embryo on the part of any one stem cell occurs only as a result of injury or death to other cells, or as a result of experimental intervention, and such switching is not usual or ordinarily in the course of the embryo’s development. When occurring naturally, such shifting works to maintain the embryo’s separate, distinct, and unified existence. To talk as if every cell is naturally and always "undetermined" in every embryo overstates the biological evidence. 3. Monozygotic twinning, where two or more individuals emerge from one embryo, can be explained in ways that are consistent with the observed biological phenomenon and that still permits the original embryo, as a philosophical matter, to be identified before twinning as an individual human being. First, the being in existence at fertilization could continue to exist through and after the point of twinning, and by a process of natural cloning, a new being comes into existence. Second, the being in existence from fertilization dies in the process of twinning and two or more new, separate, and internally unified individuals come into existence.[33] 4. Monozygotic twinning is extremely rare. The chances that any one particular zygote or embryo is actually living an indeterminate, non-individuated existence would be too small a basis on which to proceed with any confidence that experimentation in any one case will not destroy an individual living being. An issue of such importance deserves an extended examination within which experts from both sides would have a chance to document their respective cases. The hearings before this Joint Committee mark an excellent beginning. Both sides were given a fair opportunity to present their views. However, leading authorities from the disciplines of embryology, cellular and microbiology, and genetics as well as philosophy would provide this Committee with an even broader and deeper base of relevant scientific information. A public policy issue of such fundamental import deserves the most careful and far-reaching examination possible. The Massachusetts Catholic Conference, as always, stands ready to help the Committee find experts, collect data, and whatever else it takes to ensure a fair and full inquiry into the question of whether to permit embryo-destroying stem cell research. NOTES [1] Commonwealth v. Webster, 59 Mass. 295, 303 (1850). [2] Emphasis added. See M.G.L. Chap. 277, § 39 (determining the construction of words used in indictments); Commonwealth v. Campbell, 375 Mass. 308, 312 (1978) (incorporating identical definition); Commonwealth v. McCauley, 355 Mass. 554, 559 (1969) (same); Commonwealth v. Gricus, 317 Mass. 403, 411 (1944) (observing that when a felony "causes the death of a human being, the killing is with malice aforethought and is murder"). See also Porter v. Sorell, 280 Mass. 457, 461 (1932) construing the Massachusetts wrongful death statutes as civil measures intended "to punish those who through [noncriminal] negligence cause the death of a human being"). [3] Commonwealth v. Demboski, 283 Mass. 315, 322 (1933) (emphasis added). See also Commonwealth v. Simpson, 434 Mass. 570, 590 (2001) (defining involuntary manslaughter as "an unlawful homicide (1) where wanton and reckless conduct causes death, or (2) where an unintentional killing ‘result[s] from a battery not amounting to a felony which the defendant knew or should have known endangered human life’") (citation omitted) & Commonwealth v. Jackson, 432 Mass. 82, 89 (2000) (referring to felonious conduct "inherently dangerous to human life"). [4] Commonwealth v. Cass, 392 Mass. 799, 801 (1984) (construing M.G.L. Chap. 90, § 24G(a)). [5] Cass, 392 Mass. at 801. See also Commonwealth v. Lawrence, 404 Mass. 378, 398 (1988) (Abrams, J., concurring) ("[The defendant] argues that Massachusetts law does not recognize a fetus as a human being for purposes of construing the common law crime of murder. This argument is clearly incorrect in light of Cass, which address not only the vehicular homicide statute but also the common law."). [6] Id. [7] M.G.L. Chap. 112, § 12K (providing definitions applicable to abortion statute). [8] The individual state statutes, resolutions and court opinions are listed in Daniel Avila, The Present Standing of the Human Embryo in U.S. Law, 1 Nat’l Catholic Bioethics Q. 203, 213 n.55 (2001). [9] Such opinions were presented to the Joint Committee on Health Care, claiming for example that the newly conceived human exists as water up to forty days from conception (from the oral testimony of a woman describing her religious views) or is only an "unenabled, unindividuated ‘epidosembryo’, . . . a beneficence to the common weal" solely as an extrinsic source for stem cells, and not as an intrinsically valuable human being. Louis Guenin, Testimony before the United States Congress, page 59, in Committee Briefing Packet. [10] The states include Arizona, Illinois, Indiana, Louisiana, Minnesota, Missouri, North Dakota, Ohio, Pennsylvania, South Dakota, and Utah. See citations in Clarke Forsythe, Human Cloning and the Constitution, 32 Valparaiso U. L. Rev. 469, 499 n.136 (1998). [11] Roe v. Wade, 410 U.S. 113 (1973); Moe v. Secretary of Admin. & Finance, 382 Mass. 629, 647 (1981). [12] Most abortions are performed at least 8 weeks after fertilization, a stage of human development that very few abortion rights leaders deny is human life. While a majority of the United States Supreme Court continues to insist that fetal existence even at nine months gestation and at least partially through birth constitutes only "potential life" (Stenberg v. Carhart, 120 S. Ct. 2597, 2605 (2000)), the abortion rights leaders are more forthcoming. Consider the following quotes: "I agree that the way in which the arguments for legal abortion have been made include this inability to publicly deal with the fact that abortion takes a life"—Frances Kissling, Catholics for a Free Choice, Ms. Magazine, May/June 1997, at 67; "I think we have deluded ourselves into believing that people don’t know that abortion is killing"—Faye Wattleton, former President of Planned Parenthood USA, Ms. Magazine, May/June 1997, at 67; "Sometimes a woman has to decide to kill her baby. That is what abortion is"—Judith Arcana, pro-choice author and educator, Chicago Weekly Reader, Feb. 17, 1995; "[T]he pro-life slogan, ‘abortion stops a beating heart,’ is incontrovertibly true"—Naomi Wolf, pro-choice author, New Republic Magazine, Oct. 16, 1995, at 29; "We have reached a point in this particular technology where there is no possibility of denial of an act of destruction by the operator. It is before one’s eyes"—Dr. Warren Hern, Director of Boulder (Colo.) Abortion Clinic, Remarks at a meeting of the Association of Planned Parenthood Physicians, San Diego, Oct. 26, 1978; "I have angry feelings at myself for feeling good about grasping the calvaria (head), for feeling good about doing a technically good procedure which destroys a fetus, kills a baby"—A New Mexico abortionist quoted in Diane M. Gianelli, Abortion Providers Share Inner Conflicts, Am. Med. News, July 12, 1993, at 36. [13] In 1850, the state’s highest court acknowledged that "homicide may be lawful or unlawful" and listed the following examples of then-lawful forms of killing: the "war upon an enemy in battle", the public "execution of justice upon a criminal, pursuant to a proper warrant", and the private justifiable resort to "self-defense". Commonwealth v. Webster, 59 Mass. 295, 303 (1850). [14] Moe v. Secretary of Admin. & Finance, 382 Mass. at 658 n.21. [15] Webster v. Reproductive Health Services, 492 U.S. 490, 505 (1989). [16] Commonwealth v. Cass, 392 Mass. 799, 801 (1984). [17] 392 Mass. at 806. [18] Id. at 807. [19] 352 Mass. 446 (1967). [20] Id. at 449 (construing M.G.L. Chap. 229, § 2). [21] 386 Mass. 540, 563 (1982) (quoting Restatement (Second) of Torts § 869 comment d (1979)). [22] 419 Mass. 693, 695, 696 (1995). [23] 419 Mass. at 695. [24] See, e.g., Commonwealth v. Edelin, 371 Mass. 497, 511, 512 (1976) (overturning conviction of doctor for death of a child during failed abortion and delivery because there was "no indication that [the defendant] had a living being in his hands" at the time of the alleged homicidal conduct, and "[m]anslaughter assumes the victim was a live and independent person"). [25] A.Z. v.B.Z., 431 Mass. 150, 151 n. 1 (referring to a report of the Ethics Committee of the [then-named] American Fertility Society, Ethical Considerations of Assisted Reproductive Technologies). [26] 431 Mass. at 152-53. [27] Id. at 160. [28] The leading treatise on human embryology refuses to use the term preembryo because scientifically speaking it is "ill defined and inaccurate." Ronan O’Rahilly & Fabiola Muller, Human Embryology & Teratology 55 (1996). In addition, Prof. Lee Silver of Princeton University, an advocate for cloning and destructive embryo research, has admitted that IVF researchers embraced the term preembryo ‘for reasons that are political, not scientific.’ Lee M. Silver, Remaking Eden: Cloning and Beyond in a Brave New World 39 (1997). [29] The Court takes advantage of the etymological fact that "conception" could refer to the beginning of both the new human’s life and the new mother’s pregnancy. According to MerriamWebster’s, conception is "(1) the act of becoming pregnant: the state of being conceived. (2) EMBRYO, FETUS". Merriam-Webster’s Collegiate Dictionary 238 (10th ed. 1999). The 18th and latest edition of Taber’s Cyclopedic Medical Dictionary, available on the web, defines conception as the "union of the male sperm and female ovum; fertilization", and makes no reference at all to implantation. A quick survey of other popular sources reveals widespread acceptance of this understanding of the term. The heavily visited web sites for "epregnancy.com" and "pregnancytoday.com" inform parents and parents-to-be that conception refers to "the union of the sperm and the ovum" and thus, at conception, "when the sperm penetrates the egg, a new life has been created". Finally, it distorts the intention of pro-life inspired laws to presume that the ultimate objective of a legislative reference to "conception" is merely to protect pregnancies from interruption rather than human lives from destruction. [30] Dr. Guenin indicated his support for the philosophical view that a human embryo could not qualify as a "person" because the entity is not a rational being, i.e., could not immediately express thoughts, feelings, or otherwise interact. Dr. Guenin appears confused about the difference between the classical understanding of "rational being" and the behavioral act of "being rational". Contrary to Dr. Guenin’s assertions, philosophers use "rational being" to indicate that members of a particular species bear a trait characteristic of the species that gives each member the biological potential to develop a brain, etc. Moreover, the rationality test for personhood has garnered considerable criticism for reviving an old Cartesian supposition that the mind and the body are split realities and that the person exists solely within the mind. [31] An issue not raised in the hearings, but often mentioned in the debate, is the issue of size. How can "dots" be treated as equal to a baby 21 inches long at delivery? If human beings can exist at such a small size, then logically size should not matter. But how can something as small as a period have any value or significance? Just as a dot despite its small size can make a meaningful difference in the two sums of $1.0000000000 and $10000000.00, so too a human zygote can possess a life meaningful in the law’s eyes as a member of the human species. When applying the homicide code, discrimination according to size is just as arbitrary as discrimination based on skin color or life expectancy. [32] The argument is distilled from the following articles, all of which provide careful and compelling documentation identifying the human embryo as an individual member of the human community: The Identity and Status of the Human Embryo: Proceedings of Third Assembly of the Pontifical Academy for Life (Juan de Dios Vial Correa & Elio Sgreccia, eds. 1999); Benedict Ashley & Albert S. Moraczewski, Is the Biological Subject of Human Rights Present From Conception?, in The Fetal Tissue Issue: Medical and Ethical Aspects (Peter J. Cataldo & Albert S. Moraczewski eds. 1994); Mark Johnson, Quaestio Disputata: Delayed Hominization, Reflections on Some Recent Catholic Claims for Delayed Hominization, 56 Theological Studies 743 (1995); Mark Johnson, Quaestio Disputata: Delayed Hominization, A Rejoinder to Thomas Shannon, 58 Theological Studies 708 (1997); Dianne N. Irving, The Woman and the Physician Facing Abortion: The Role of Correct Science in the Formation of Conscience and the Moral Decision Making Process, Linacre Quarterly, Nov. 2000, at 21; Dianne N. Irving, When Do Human Beings Begin? "Scientific" Myths and Scientific Facts, 19 International Journal of Sociology and Social Policy 22 (1999); W. Jerome Bracken, Is the Early Embryo a Person?, Linacre Quarterly, Feb. 2001, at 49. [33] The phenomenon of chimeras, where two or more living beings combine together is susceptible to the same explanation but in reverse: the combination could destroy all but one of the beings, or result in the creation of an entirely new human life after the deaths of the previously existing beings. Massachusetts Catholic Conference, West End Place, 150 Staniford Street, Boston, MA 021142511, Phone: 617-367-6060; Fax: 617-367-2767 Author's Email: danielavila@macathconf.org Website: http://www.macathconf.org