Valuing the Beginning of Life: Bioethics and Premarital Counseling
By helping newly engaged couples navigate potentially difficult family-planning issues, pastors have the privilege of laying the stones for the foundation of a Christian home.
By Christina M.H. Powell
One of the great joys of pastoral ministry is the privilege of guiding people through major life milestones such as joining two lives in matrimony. During premarital counseling, pastors have opportunity to educate young couples about many issues related to married life, including bioethical issues. Let’s explore the bioethical issues that couples starting married life will face and ways that teaching about these issues can be integrated into premarital counseling.
Cultural Versus Biblical Perspectives on Childbearing
Couples approaching their wedding day are often wrapped up in the excitement of sharing life together as husband and wife. The thought of becoming parents and sharing life together as a family often feels like a distant possibility, an era of life that is yet to come. However, premarital counseling provides an ideal opportunity to discuss issues related to childbearing. Such issues include choices regarding the timing of childbearing and the desired number of children as well as issues related to reproductive technologies.
The age of the couple being married will influence their views on the ideal timing of childbearing. A couple in their early to mid-20s may have goals they hope to accomplish before starting a family. For example, one or both may desire to complete schooling or establish a career and achieve a certain degree of financial stability before having children. Couples marrying in their 30s may have accomplished educational, career, and financial goals and be ready to have children.
While there is wisdom in a couple waiting to have children while they strengthen their relationship as a couple, children should never be viewed as a burden or impediment to achieving other goals. A biblical view of childbearing is that “sons are a heritage from the Lord, children a reward from him” (Psalms 127:3). One of God’s first commands to mankind was to “be fruitful and increase in number” (Genesis 1:28). If we take the long view of life, the ability to have children who will touch the future after our days on earth have ended is one of God’s great gifts to us. Children bring meaning to our lives that transcends the constraints of our limited life spans.
Unfortunately, the urgent often supersedes the important. The press of present goals can get in the way of achieving lifelong goals. The goal of raising godly children can be pushed aside by the concerns of the moment. Our culture places high value on outward appearances and career success. In such an environment, the sacrifices that motherhood demands from a woman, such as the physical changes that come during pregnancy and the diminished time available for career advancement that follow after a child is born, can persuade a woman to delay or avoid having children. Similarly, the high value our culture places on accumulating material wealth can dissuade a man from embracing fatherhood until he feels that he has sufficiently increased his earning potential.
For the Christian couple, every child is planned by God, even if his birth was unplanned by his parents (Psalm 139:15,16; Ephesians 1:4–14). While it may be advisable for a couple to take measures to attempt to control the number of children and the spacing between children, a Christian couple must be prepared to love and accept any child that comes along.
As a part of premarital preparation, couples can be encouraged to view children as blessings from God and counseled to take the responsibility of raising children seriously. Finally, couples can be advised to approach decisions about family planning with prayer (James 1:5), honest communication with each other (Ephesians 4:25), and respect for the sanctity of human life (Jeremiah 1:5).
What Makes Human Life Sacred?
When we speak of the sanctity of human life, we are affirming the fact human life is sacred. Sacred means belonging to God. Human life belongs to God. “For none of us lives to himself alone and none of us dies to himself alone. If we live, we live to the Lord; and if we die, we die to the Lord. So, whether we live or die, we belong to the Lord” (Romans 14:7,8).Human life is eternal (Matthew 25:46). Furthermore, human life is sacred because we are made in the likeness of God (Genesis 5:1). Human life is unique from all other life created by God in that Christ came down from heaven and became a man (John 1:14) to save us (1 Timothy 1:15). In turn, we have been given the freedom to choose to believe in Christ and be reconciled to God (John 3:16). The gospel underscores the sanctity of human life. Since the Bible is so clear on the sacredness of human life, the question we must ask is: When does life begin?
When Does Life Begin?
When did you, as a person, enter into existence? As a toddler taking your first wobbly steps, were you you? When you were a one-day-old infant? Did you exist while in your mother’s womb when your heart first started to beat in rhythm? Did you exist when you were only a ball of cells containing the unique genetic code that defined your lifelong physical characteristics? As an unfertilized egg, had your life yet begun?
Human development is a continuum from conception to the end of life. A blastocyst (ball of cells that later form an embryo and a placenta) differs greatly from a toddler snacking on cereal and drinking apple juice at the family’s kitchen table. However, if we need to draw a line to mark the beginning of a new life, that line is most logically drawn at conception. An unfertilized egg does not yet possess the full complement of genetic code needed to define a unique individual. The moment an egg is fertilized, however, a new individual with a unique genetic code is formed. Given time and the proper nourishment, that single cell is capable of developing into an adult human being comprised of more than ten trillion specialized cells.
The Bible affirms that God’s presence and purpose for our lives are established while we are still in our mother’s womb (Psalm 139:12-16; Luke 1:39-44). Thus, we must conclude that God values unborn children.
Eve: Fearfully and Wonderfully Made
The Psalmist appreciated how the human body is “fearfully and wonderfully made” (Psalm 139:14). One dramatic example of the wonders of the human body is the cyclical rhythm of female fertility and the capacity of a woman’s body to protect and nurture new human life. A basic understanding of female biology is invaluable for the man preparing for marriage. While such an understanding can come from a science textbook, a pastor conducting premarital counseling can provide the moral guidance needed for making wise choices about reproductive issues.
Aspects of female fertility that are important to understand in relation to family planning decisions include ovulation, alterations in the endometrial lining, and hormone regulation of fertility, pregnancy and breastfeeding. A healthy man is always fertile because sperm are continuously being produced within his body at the rate of about one thousand per second. A healthy female, however, is only fertile about one week out of every month, typically producing one egg per monthly cycle.
Ovulation is the process by which an egg is produced and discharged from an ovarian follicle. An egg will die if it is not fertilized within 24 hours of ovulation. Conception occurs when the sperm fertilizes the egg. Ovulation occurs once a month, but a female is considered fertile when she has cervical fluid that can keep sperm alive as they wait for the mature egg to be released. Sperm can stay alive in a fertile woman’s body for up to 5 days. Once ovulation has passed, conception is not possible for the remainder of a woman’s cycle.
Hormone-based birth control methods primarily work by preventing ovulation, although they also have a secondary effect of inhibiting transport of sperm through the cervix by thickening cervical mucus, thus preventing fertilization of the egg. Barrier birth control methods prevent sperm from fertilizing the egg. Fertility awareness methods detect changes in basal body temperature and cervical mucus that signal ovulation. This information can be used to prevent or achieve pregnancy.
Ovulation is suppressed in a woman who is nourishing her baby exclusively by breastfeeding, making breastfeeding a method of naturally spacing children. However, if a woman chooses to feed her baby on a schedule or offers bottles and pacifiers to her baby in addition to nursing, she may begin ovulating again soon after birth.
Once an egg is fertilized, the next discrete step in the journey from conception to birth is implantation. About a week after conception, the fertilized egg reaches the uterus after making the journey down the fallopian tube. The fertilized egg has now become a ball of cells known as a blastocyst. If the blastocyst can successfully implant in the endometrial lining of the uterus, then human chorionic gonadotropin (hCG) will be activated. This is the hormone detected by pregnancy tests. Normally, by this point in the woman’s cycle, the endometrial lining has thickened so the embryo has a warm, nutrient-rich place in which to implant. Some birth control methods, such as the intrauterine device (IUD), sometimes work by impeding implantation, although their primary mechanism of action is preventing fertilization.
Making Informed Decisions About Family Planning
One of the most important principles of ethical medical care isinformed consent. Informed consent means a patient accepts a proposed decision or medical intervention after first understanding the nature of the decision or medical intervention; the reasonable alternatives available; and the risks, benefits, and uncertainties related to the medical intervention; and any available alternatives. In keeping with the principle of informed consent, a couple making a choice about birth control should make sure they understand the risks and benefits of the type of birth control they are considering.
Instead of recommending or condemning a certain form of birth control, I prefer to suggest questions a couple should ask when making a decision about family planning. Technological advances may change the family planning options available to a couple in the future, but questions regarding the choice of birth control methods are timeless. If you teach a couple to ask the right questions as a part of premarital preparation, the couple will be capable of making wise choices both now and in the future as new options become available.
Good questions for a couple to ask their doctor about birth control methods include questions about a method’s mechanisms of action. Does the method work by preventing ovulation, by preventing fertilization, or by preventing implantation of a fertilized egg, or through combined mechanisms of action? Is the mechanism of action unclear or unknown? Can the mechanism of action vary depending on certain factors, such as how and when the method is employed or the presence of other health conditions? Other good questions to ask a doctor regarding a birth control method involve future health considerations. How effective is this method? Is the method easily reversible when pregnancy is desired? Can the method adversely affect future fertility? Does this method lead to a higher risk of ectopic pregnancy? What are potential side effects and health concerns for those who employ this method of birth control?
Good questions for a couple to ask themselves regarding a birth control method they are considering using include: Are we comfortable enough with this method to use it faithfully so the method will be effective for us? Do we understand how to correctly employ this method? Do we want to have children (or more children) in the future? Are we both happy with this choice? Does this choice present a health risk for either of us? Does this choice conflict with our beliefs concerning the sanctity of human life?
Respect for the Needs of Each Spouse
Helping a couple learn how to make a wise choice regarding a family planning method fits into the broader category of counseling couples to respect the needs of one another when making decisions within their marriage. The apostle Paul reminds believers in 1 Corinthians 7:3–6 of the importance of meeting each other’s needs for physical intimacy within the marriage. It is important that both husband and wife are at peace with whatever method of family planning, if any, the couple has chosen.
Similarly, health considerations should be part of the decision. In some cases, a woman may have a medical condition that would make a future pregnancy a risk. In other cases, certain birth control methods may place a woman at greater risk for blood clots, stroke, and heart attacks. The principle outlined by the apostle Paul should be applied within the marriage relationship: “Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves. Each of you should look not only to your own interests, but also to the interests of others” (Philippians 2:3,4). Neither spouse should feel pressured by the other to undergo a procedure or use a birth control method that is not in the best interests of his or her long-term health.
As a couple learns to work through the challenging topic of family planning while respecting each other and respecting the beginning of life, they will be taking an important step toward strengthening their relationship. Someday their strong marital relationship may become the foundation on which a godly Christian family can be built. By helping newly engaged couples navigate these potentially difficult issues, pastors have the privilege of laying the stones for the foundation of a Christian home. Strong homes make for strong churches and an effective witness to the world around us. What great joy can come from building God’s kingdom one couple at a time.