MEDICINE: ethics of artificial reproduction - a C-A-N- Perspective by Dr Carolline Berry
Artificial reproduction: applying Christian principles to ethical quandaries
Infertility (no pregnancy after 1-2 years unprotected intercourse) affects about 1 in 8 couples and gives rise to considerable distress. In around one third of couples the problem originates in the man, in another third in the woman and in the final third no cause is identified.
A number of techniques have been developed to overcome the problem. These range from artificial insemination by husband's sperm through GIFT (Gamete Intra-Fallopian Transfer), ZIFT (Zygote Intra- Fallopian Transfer), I.V.F. (In Vitro Fertilization), Gamete Donation and finally surrogate motherhood.
The techniques of I.V.F. are also used to overcome the risk of a genetic disorder in the child, on the basis of Pre-Implantation Genetic Diagnosis (PIGD).
The first ever I.V.F. or "test-tube" birth occurred in England in 1978; the baby is now a healthy young woman. Since then many thousands of other such babies have been born and these various techniques have been developed.
The law of the land
In the UK, all techniques involving the fertilization of ova outside the body are regulated by the Human Embryology and Fertilization Act 1990. Centres undertaking this type of treatment have to be licensed and inspected and must keep careful records of their activity and success rates. Centres which fail to reach the required standards, either technically or ethically, can have their licence withdrawn.
Key ethical issues
In all the techniques the fertilization of the egg occurs without the act of sexual intercourse. The sperm have to be obtained by masturbation. This is in reverse to the use of contraception, which enables a couple to have intercourse but no baby.
The use of donated gametes or a surrogate mother introduces a third party (or even a fourth or fifth potential donor) into the creation of the child. This alters the symbolism of the bond between the child's two parents, quite differently from adoption.
Is the pre-implantation embryo a person who warrants care and protection or can this embryo be disposed of or used for research? What should be the fate of spare embryos generated by I.V.F.? It should be remembered that none of these techniques would be possible if many pre-implantation embryos had not been used in research into the appropriate tissue culture conditions etc.
The people involved. When donors or surrogates are involved, they must be protected from financial and emotional exploitation. For example, what allowance should be made for the impact on a surrogate mother of giving up the child she has carried during the pregnancy? Above all, the hoped-for child needs to be protected. Should he or she be informed in due course? How will the child then cope with this unusual form of parentage? Should it be possible for gamete donors to be traced by the child when adult?
Use of resources and equality of access. These techniques are expensive. Should health authorities purchase them and how should they prioritise? If these techniques are only available through the private sector, is it just that some can buy them and others not?
Could the use of pre-implantation testing lead to a world of 'designer babies' or any undesirable forms of genetic manipulation?
There is ample evidence in the Bible of God's concern about infertility and the heartbreak it brings, illustrated well by the anguished prayer by Hannah who then became the mother of Samuel (1 Samuel 1). Abraham and Sarah had to wait longer than they felt able before their promised son Isaac was born (Genesis 16-21). Also several Bible heroes have quite unconventional parents and upbringing: Moses was brought up as an adopted son of a royal princess (Exodus 2), Samuel was brought up largely by the temple priests (1 Samuel 2-3) and John the Baptist was born to quite aged parents (Luke 1).
The Lord Jesus Christ declared that our attitude towards Him is more important than blood-ties (Matthew 12: 48-50).
So it is important to try to think biblically about these fraught ethical issues.
Christians reach different conclusions in this highly controversial area but there are certain biblical principles on which all agree: the importance of truth and integrity; the value of the individual; the value of the family; and justice and protection for the weak.
The importance of truth and integrity. An honest approach is essential for the counselling of both potential parents and donors. Those embarking on these forms of treatment need to be aware of the cost in both emotional and financial terms.
The children born need truthful information and parents need to be encouraged to be open with them about their origins. Yet the confidentiality of the donor also needs consideration: his or her situation is different from that of the birth mother of an adopted child; any gain to the child of knowing the donor could be well outweighed by the burden on the donor. (Recent UK legislation will allow donors in future to be traced.)
The value of the individual is a key Christian concept and leads us to consider the status of the embryo.
Some believe that full personhood is present at the moment of conception. Those who take this view are virtually precluded from using any of the techniques under discussion.
Others believe that, as the techniques of artificial reproduction are now available, they can be used provided no pre-implantation embryos are discarded (despite their use in research to develop the I.V.F.).
Yet others believe that the balance of the evidence indicates that the pre-implantation embryo does not have any personal status and so it can legitimately be discarded (and used for research). Reasons for this stance include the facts that fertilized ova are unwittingly lost naturally and during certain forms of contraception (including the widely used 'mini-pill' and contraceptive implants), that there is great plasticity in development subsequent to this very early embryo and that such a small proportion of the cells goes on to become the embryo (as distinct from the placenta and cord). Most importantly, the teaching throughout both Old and New Testaments chiefly concerns how we relate to God and to one another. If then the essence of personhood is relationship, the image of God that distinguishes human persons (Genesis 1:26-27) is unlikely to be realised in the bundle of genes which constitutes the early human embryo. Relationships to a person who will later be born may begin to flicker into life as the mother becomes aware of the unborn baby's presence in her body. On this argument, involvement in the processes of selective fertilisation and implantation might advance the formation of relationship but the genetic manipulation itself would not.
The value of the family is regarded in different ways in this context.
To many, the 'making' of babies in the laboratory rather than 'begetting' them through the loving union of the potential parents seems alien to the God-given concept of the family. Some regard the masturbation necessary to donate sperm as a wrong use of a man's sexual organs.
Others accept the use of artificial techniques on condition that only the gametes of the couple concerned are used. Gamete donation is sometimes said to be equivalent to adultery but many Christians consider that adultery involves the sexual act outside the partnership, whereas I.V.F. is a medical intervention that introduces genes from without. Even taking such a view, concerns remain about the potential for 'genealogical bewilderment' for the child that is inherent in any form of gamete donation and this alone persuades many to advise against its use.
A minority believe that a gift of gametes is morally permissible because genes are part of the ‘building blocks' for the future person rather being the actual person.
Justice and protection for the weak. There is universal agreement that the welfare of any child has the highest priority and a clause to that effect is included in the 1990 Act of Parliament. Yet this aspect is easy to forget when faced with a couple desperate for a baby. Furthermore, the interpretation of this principle is difficult because neither parenting ability nor stability of the home can be taken for granted. An extreme is a request for a pregnancy from a same-sex couple: this is rare but does occur; the use of these techniques would be opposed by those who believe that the Creation pattern is for a baby to have two parents of opposite sexes.
A surrogate mother who has made a strong bond with the baby she carried is exceedingly vulnerable. The interests of this deeply involved third party should be kept in perspective with the sometimes overwhelming desire of the infertile couple for a child. When children are seen as gifts from God, there is no right to demand to have a child. The distress of the childless must be kept in perspective lest the lives of others are trampled on.
Yet the vulnerable include the childless: they too are in need of protection. Wisdom is needed in order to discern when a couple needs protecting from insufficiently considered response to the attractions of using the reproductive technology that is available.
These new technologies have opened the door to a host of possibilities but it should be clear that they illustrate the saying that 'what is possible is not always what is right'. Some Christians see none of these techniques as permissible. Others believe they can be used responsibly in ways compatible with Christian principles.
An example follows of a couple faced with the likelihood of passing on a genetic disorder to a baby of their own, showing how difficult these decisions can be.
Caroline Berry (formerly Consultant Clinical Geneticist at Guys Hospital, London; currently Secretary of Christians in Science)
Begotten or Made. Oliver O'Donovan. OUP 1984.
Beginnings. A.C.Berry. Christian Medical Fellowship 1993.
Personal Origins. Board of Social Responsibility of the C of E. Church House. Revised edition 1997.
Trying For a Baby. Pete Moore. Lion 1996.
Christian Views of the Early Embryo. Caroline Berry. CMF
This C-A-N- Perspective is Dr Berry's personal adaptation of a document that was prepared by the CMF Study Group and is published on the CMF website as File no. 6, "Artificial Reproduction". For a statement agreed by the Christian Medical Fellowship, see the full original document.
This and other Files on issues of medical ethics can be viewed on and downloaded from the Literature section of the website of the Christian Medical Fellowship, as can also short reviews of CMF book[let]s on Christian approaches to medical issues, which are purchasable from CMF in printed form. The URL for all categories of CMF publications is www.cmf.org.uk/pubs/pubs.htm