By Ellen Painter Dollar
In Part 1 of this series, I told my story of living with a genetic disorder and choosing to have biological children with a 50/50 chance of inheriting the disorder. My exploration of preimplantation genetic diagnosis (PGD—in vitro fertilization with the added step of testing fertilized eggs for a particular mutation) led me to focus on reproductive ethics in my work as a writer. Here in Part 2, I’ll summarize current ethical perspectives of the Roman Catholic, Protestant and Jewish traditions.
The Roman Catholic Tradition
Catholic opposition to artificial contraception, abortion, and any type of assisted reproduction, from artificial insemination up to IVF, PGD and surrogacy, stems from several basic principles:
• Marriage, instituted by God to unite one man and one woman, has two necessary and complementary purposes: unitive (two people becoming one flesh) and procreative (producing children). Each conjugal act that takes place in a marriage needs to be open to the potential for procreation, even if each act does not (or even, in the case of an infertile couple, cannot) result in conception.
• Sexual intercourse and procreation, both God-given blessings reserved for marriage, cannot be separated. Sex should not occur without the potential for procreation (hence the objection to artificial contraception), and procreation should not occur without sex (hence the objection to any method of assisted reproduction in which conception occurs independently of intercourse).
• When people separate the unitive and procreative purposes of marriage, deciding when they are and are not open to having a child through calculated use of artificial contraception, children become a project to be achieved or a product to be obtained to fulfill parental desires, rather than a gift that arises naturally from the marital union.
• The temptation to view children as entitlements or commodities, rather than gifts, grows with the use of reproductive technology. Because IVF and PGD require embryos to be selected for implantation in the mother’s uterus, an element of quality control is introduced (i.e., choosing the “best” or potentially healthiest embryos). This element, again, transforms children from gifts of a loving God to products manufactured by medical personnel to parental specifications.
• Because intercourse and conception are inextricably linked with each other, and intended for an exclusive marriage relationship, any reproductive technology that introduces a third party into conception, such as with donor gametes or surrogate motherhood, is unacceptable.
• An embryo is fully human, with all the rights of a human being created in God’s image, from the moment of conception. Any use, destruction or manipulation of an embryo, including freezing, genetic testing, disposal, abortion or medical research, violates the embryo’s dignity as a human being.
Many Catholics argue that they are not so much against all these technologies as they are for a perspective on marriage and sexuality that is radically different from that of mainstream culture. For example, Catholics who advocate natural family planning (NFP) argue that couples can make wise decisions about family size and pregnancy timing while also being open to God’s design for sex and procreation within marriage. In NFP, couples avoid conception at certain times by abstaining from sex during the wife’s fertile period, which she determines through detailed observation of such factors as body temperature and cervical mucus. Those who practice NFP argue that by subordinating their sexual desires to the God-given fertility cycle and their sense of when and how God calls them to parenthood, NFP enhances marital intimacy and interdependence, bringing marriage closer to the way God intended it.
Mainline Protestant Traditions
Mainline Protestantism, of course, comprises a diverse group of churches, so there is no one perspective on reproductive ethics. There are, however, some common assumptions and values that inform many Protestant churches’ discussion of the topic, as well as some specific conclusions that several mainline Protestant denominations share.
• Mainline Protestant churches tend to value individual autonomy and choice, and assert that individual Christians can inform their own consciences to grapple with moral decisions with the guidance of the church, scripture, tradition and reason.
• Given the value of autonomy and conscience, many Protestant churches encourage both clergy and laypeople to educate themselves about reproductive technology and related ethical concerns. Pastoral and genetic counseling are held up as vital resources for church members dealing with infertility or family history of genetic disease.
• Protestant traditions tend to emphasize marital companionship more than procreation, and allow more leeway in how the purposes of marriage play out for individual couples. For example, some argue that while it’s important for married couples to be open to the possibility of children, such openness occurs in the context of a lifelong marriage relationship, not just when the couple engages in discrete acts of intercourse. Therefore, using contraception to limit family size and time pregnancy is acceptable (and some argue further that because Catholic natural family planning, or NFP, attempts to control fertility just as artificial contraception does, there is no moral difference between the two). It is also acceptable to separate sex and procreation in limited instances, by using assisted reproduction to overcome infertility within a marriage.
• Many Protestant churches approve the use of assisted reproduction techniques to help couples conceive children within a marriage. However, techniques that compromise the exclusive marriage relationship or that allow for childbearing outside of marriage (such as donor gametes and surrogacy) are viewed with concern or disapproved altogether.
• Genetic screening is generally acceptable for disorders that significantly affect health and well-being, but should not be used either for gender selection (except in the case of sex-linked genetic disorders) or screening for non-disease-related traits. Human cloning is unacceptable.
• Embryos have moral status and should be treated reverently, but their status is not equal to that of a more developed human life. Embryos should not be created for the purpose of being destroyed through scientific research. Donation of embryos left over from IVF cycles is viewed more favorably, but efforts should be made not to produce more embryos than can reasonably be used in an IVF cycle.
• Protestant documents tend to emphasize issues of justice, recognizing the potential for assisted reproduction and genetic screening to be used in ways that compromise the inherent dignity of every human being, such as by ensuring that certain types, classes or races of people are not born.
Evangelical Protestant Traditions
With their strong pro-life ethic, evangelical Protestants tend to have more in common with Roman Catholics than with mainline Protestants when it comes to reproductive ethics. Concern for the human dignity of embryos fuels evangelical opposition to reproductive technology, such as IVF, that leaves behind thousands of unused, frozen embryos, as well as to the use of those embryos in stem-cell or other medical research. Preimplantation genetic diagnosis (PGD) is problematic both because it requires discarding embryos testing positive for a particular genetic disorder, and because of its potentially eugenic nature (i.e., the potential for people’s worth to be judged based on their genetic history, leading to the breeding of people for certain traits perceived as positive and the elimination of people with traits perceived as negative).
There is also an emerging openness among younger evangelicals to the Catholic practice of natural family planning (NFP) and the vision of marriage and parenthood that it entails.
Judaism emphasizes the procreative purposes of marriage—its role in fulfilling God’s command to be fruitful and multiply—to a greater extent than either Roman Catholicism or Protestantism. Having children is one of the 613 mitzvot (commandments or rules) that Jews are to live by. Persecution of Jews has reinforced their emphasis on maintaining Jewish identity and community by having Jewish children.
Judaism tends to view assisted reproduction as a tool to help Jews fulfill God’s procreative purpose for marriage. In fact, Israel has an unusually high birth rate of babies conceived through assisted reproduction (about 5 percent, compared with about 1.5 percent of U.S. babies). Because the procreative purpose of marriage is valued so highly, Jewish authorities have few reservations about separating the reproductive process from the sexual union of married spouses. Because Jewish identity is passed down through the mother, however, Jewish authorities have expressed concern with third-party reproductive technology that uses donor gametes or surrogates, which might lead to confusion over the child’s Jewish identity.
Even though Jews have been targets of eugenic policies and prejudices for centuries, they have embraced the use of both genetic testing and preimplantation genetic diagnosis (PGD) to help eradicate disorders common in the Jewish community. For example, Dor Yeshorim is a Brooklyn-based organization that has helped lower the incidence of Tay-Sachs disease (a fatal genetic disorder that primarily occurs in Jewish families) and other recessive genetic disorders through a proactive screening process. Young, unmarried Jews consent to genetic testing to identify whether they carry genes for any of a list of recessive disorders. If a couple determines, early in their dating relationship, that there is potential for marriage, they can call a special phone number, type in a PIN, and find out if both the man and the woman carry any recessive genes in common. If they do—meaning their children would have a 25 percent chance of inheriting the disorder in question—it is recommended that the couple end their relationship. The program has been successful because many couples do just that.
The Need for More Discussion
My goal in this series, again, is not to argue for any one approach as better than the others. (Although, as a good Episcopalian, I do tend toward a moderate, nuanced view of what is acceptable and unacceptable. This may doom my work to failure because, as my husband remarked recently, our culture does not do nuance very well.) Rather, I am motivated by that fact that, though Protestant resources in particular recognize the need for education, prayerful consideration and supportive counsel for both congregations and individuals making reproductive decisions, many Protestant churches, including the Episcopal Church, have not engaged as fully as they can with the moral quandaries raised by evolving technology. In the final, third part of this series, I will briefly review what the major moral quandaries are, and suggest some steps that congregations and individual Christians can take to move the discussion forward.
Ellen Painter Dollar is a writer whose work focuses on faith, parenthood and disability. She is writing a book on the ethics and theology of reproductive technology, genetic screening and disability, and she blogs at Choices That Matter and Five Dollars and Some Common Sense.