by Mandy Cox
There are a number of ethical issues regarding artificial reproductive technologies (ART). The heartache of infertility cannot be denied, and it requires a pastoral approach that recognizes these emotional challenges. However modern ART exploit the couple’s struggle and compound the heartache of infertility by victimizing the children it produces. As senior leaders at Catholic businesses, it is important to be prepared with a pastoral response that addresses the authentic struggle of the couple. At the same time, we need to uphold the dignity of the spouses and their potential children.
This post will explore the ethical dilemmas posed by ART in light of the child.
Basic Ethical Principles:
For this evaluation, it is important to understand the ethical principles of ART as it relates to the children involved. The Catechism of the Catholic Church covers the following points in detail, but I have condensed this to 5 basic principles.
- ART violates the child’s right to be conceived in the loving embrace of their parents, with whom they have equal dignity,
- The life and identity of the child is placed in the hands of doctors and biologists,
- Technology dominates over the life and destiny of the human person,
- A person cannot be owed to someone as a product that is manufactured and purchased,
- Moral technologies must be at the services of all human beings involved, including the most vulnerable – the human child.
Child as subject and gift.
The vision of each person as possessing the dignity of being created in the image of God is reflected in the moral teachings regarding ART. From the moment each person is conceived, they possess profound dignity and each action that involves this individual must respect this dignity.
Each child is their own person from the moment of conception. Philosophy uses the term subject when discussing an individual. As opposed to objects that can be used for various purposes, a subject should not be used for any purpose or reason, since it is a distinct individual.
Prior to the development of ART, the only way a child came into being was with the disposition of receiving a gift. Parents could not simply will a child into being; they could only accept the gift of a child from the Creator. Each child is its own subject, meaning it must be received as its own individual and cannot be possessed by another person.
ART violates the child’s right to be conceived in the loving embrace of their parents, with whom they have equal dignity.
The first ethical principle is that children have a right to be conceived in the loving embrace of their parents. ART separates the child’s conception from this gift of self between its parents. Even more disturbing, most parents are not properly educated or informed on the reality of the ART process. Deceptive language, such as “fertilized egg”, dehumanizes this process and separates the parents from their children that are growing in the lab. They are often not informed of how many of their children died in the days prior to transfer. The process that attempts to transfer and implant these embryos carries the potential for more embryo death. There are no regulations on the number of embryos to attempt to transfer in a given cycle. The profound expense associated with IVF puts pressure on the couple to transfer as many as “possible” to defray costs. For the lucky embryos that implant, their destiny remains tenuous, as they face the potential of “selective reduction” (abortion) if they are one of several siblings to survive implantation. They are more likely to experience complications with growth and birth than children conceived naturally. The children not selected for implantation also face an unknown future.
The life and identity of the child is placed in the hands of doctors and biologists.
Technology dominates over the life and destiny of the human person.
It is important to understand the process of ART, most specifically IVF. The typical cycle of IVF has the potential to produce a large number of embryos. The woman’s ovary is hyper-stimulated to produce as many as 20 eggs. The egg and sperm are joined, most commonly through ICSI IVF, where a lab technician discriminates and picks one sperm to be injected into each ova (egg). Often referred to as “fertilized eggs”, these children are allowed to develop in the lab for as long as a week before they are “selected” for the next steps. Some embryos will not survive the process of growing in a sterile lab, as opposed to their mother’s body. For those that survive, the next step is embryo selection. The selection criteria is arbitrary and unregulated. Most scientists rely on how the embryo “looks” at this point. Modern efforts are training AI (artificial intelligence) to determine the “quality” of the embryo. A recent article touts the success of using computers to discriminate and select which embryos are chosen to live. These computers will determine which children live up to discriminatory standards (Link).
Embryos are discarded if they do not meet requirements as determined by a specific lab. These standards are not regulated. Parents can also selectively destroy their own embryos based on their preferences, most commonly based on the sex of the child. A recent study revealed a disturbing trend that would value the potential that a child might attend an ivy league school over the other children (Link). The undesired children’s destiny is in the hands of the lab. They can be discarded, used for experimentation even without parental consent, or frozen, with their destiny determined at some later point.
A person cannot be owed to someone as a product that is manufactured.
An individual couple considering ART likely has not considered the larger consequence of creating children through this process. Their primary focus is their desire to grow their family. However, the ethical principles extend beyond a particular situation and include the wider impact of ART. As leaders at Catholic organizations, it is important to understand all of these principles.
A disturbing consequence of ART is that, once manufactured, the child may fail to live up to the manufacturers guarantee. ART have introduced a level of expectation that is completely new to the arena of human procreation. It is common practice that the parents sex-select which embryos to implant. The idea that we can select children to meet arbitrary standards is becoming pervasive, even attempting to craft them in such a way to avoid certain illnesses. In a recent story, parents are suing a doctor who failed to meet his promise that their child would be born without a specific gene associated with cancer (Link). What is not stated in these articles is that in the process of choosing certain embryos, others are destroyed or left to an unknow fate.
Efforts to edit and control the human genome are made possible by the process of manufacturing children. A physician in China served time in jail for editing the genes of embryos and allowing them to be born (Link). The practice of gene editing is undertaken in labs around the world. The complaint against this scientist was only that he did not destroy these children, as is common practice, but instead allowed them to the born. A recent publication touted the success of scientists to create mice embryos from two male mice (Link), with obvious implications to duplicate these efforts in humans.
The vulnerable are victims.
The couple and their potential children are vulnerable. Medical ethics and laws regarding informed consent are meant to protect those in vulnerable situations from being taken advantage. However, these protections are insufficient in the ART world. The medical professionals involved in this work are also vulnerable. Their desire to help childless couples is perverted by ART, and they are often unaware of alternative approaches to address infertility. But most especially the little ones are vulnerable, with no voice or vote in what is done to do them. They are no longer viewed as gift or as an individual whose dignity demands respect.
Moral technologies must be at the services of all human beings involved, including the most vulnerable – the human child.
Is there a moral and ethical approach to assist couples desiring to grow their families? Luckily the answer is yes! The modern forms of ART have not advanced much beyond their initial success in the 60’s and 70’s. These forms promise a 33% success rate at best. However, thanks to the hard work of physicians around the world, couples can receive ethical treatment for infertility. Approaches that seek to identify and treat underlying cause of infertility and restore the couple to health allows them the opportunity to achieve pregnancy within their marital relationship. These approaches don’t seek to circumvent the health issues, as with ART. This approach has even greater success, as the couple has the opportunity for future pregnancies as well. NaProTechnology is one of these medical approaches. Physicians trained in NaProTechnology evaluate the health of the couple and seek to treat the underlying health issues and provide pregnancy support with great success.
A pastoral response.
The first child born through IVF in America is 45 years old this year. A pastoral response must take into account that many people we interact with are personally affected by IVF. While it is not necessary to list them in a particular conversation, the ethical principles above provide the foundation for a pastoral response.
Here are some practical steps to consider when responding to the issues around ART.
- Affirm the good intentions of couples to grow their family.
- Couples should be made aware of the effective medical treatments that are available to them that are ethical and moral. Every couple is encouraged to pursue testing, procedures, and treatments that restore health to the couple, allowing them to conceive children within their relations as husband and wife. These treatments respect the dignity of the whole family: father, mother and child.
- Find local resources that can assist couples struggling with infertility. Engage with CBA to review your plan coverages and language to maximize coverage of moral treatments for infertility. Check out our blog here to learn how we help our members in this work.
- For couples considering ART: While the intention to have children is a wonderful thing, not all avenues of having children are ethical or moral. Most couples are not aware of the full process of ART and they deserve full understanding before pursuing this path. Using the ethical principles above, ask to share the ethics as they relate to the potential children that may be conceived.
- For couples that have already gone through ART: All children are a gift from God, no matter the circumstances around their conception. The ethical and moral teachings around ART uphold the dignity of the couple and the children that are conceived, but do not undervalue children who are created from these methods. While the motive of couples who have used ART is admirable, the good desire does not make ART ethical or moral. We are happy that they may have welcomed a child, but we should encourage them evaluate ART in light of what they know now.
- ART seem to be the best or only answer to infertility. However, it is important that any couples considering this path take seriously all of the aspects of the process. Each couple is encouraged to consider the ethical principles laid out here. Ethical evaluations often present personal challenges. We should not avoid these challenges, but be open to make new decisions based on new information we encounter.
Preparing leaders for difficult conversations through formation.
In the coming months, CBA will roll out formation modules for the senior leaders at CBA member organizations. These modules will explore challenging areas, providing a review of the essential elements of Church teaching on these topics, as well as practical tools to respond to these challenges. Our Everyday Ethics post from last month provides a glimpse into the direction we will take.