Respecting Ethical Boundaries in Reproductive Medicine
By Christina M.H. Powell
As a pastor, you probably have emphasized the importance of family through sermons and church programs. The Bible affirms that children are a blessing from God (Psalm 127:3). Scripture shows that the Lord “settles the barren woman in her home as a happy mother of children” (Psalm 113:9). Yet, in our churches there are some couples who struggle with infertility. A woman’s inability to conceive and bear children can generate pain and disappointment. These feelings are intensified in an environment, such as the church, where having a family is greatly valued.
In today’s society with its reliance on scientific progress, technology promises answers for infertility. People often regard medical breakthroughs as God’s provision. Christian couples, however, must consider where to draw ethical boundaries in the field of reproductive medicine.
Respecting the Beginning of Human Life
Reproductive medicine seeks to help couples bear biological children. This is a noble purpose. Successful fertility treatments result in a new human life that might not otherwise have come into being. Doctors and patients, however, must be careful when devising treatment protocols to ensure that they maintain respect for the beginning of human life. For a Christian, children are more than the result of a technological process; they are gifts from our loving Creator.
According to the American Society for Reproductive Medicine, less than 5 percent of all infertility treatment in the United States involves in vitro fertilization.In vitro is Latin for within the glass and denotes a process that occurs in a laboratory instead of within a living organism. In vitro fertilization involves surgically removing eggs from a woman’s ovary and mixing these eggs with sperm in a petri dish. Fertilized eggs begin dividing into cells to make an embryo. These eggs are then placed into a woman’s uterus, thus bypassing the fallopian tubes where a fertilized egg normally travels to reach the uterus.
In vitro fertilization separates the moment of conception from the expression of love between a married couple. New human life begins in the laboratory, open to observation and experimentation, instead of within the protective depths of a woman’s body.
While the beginning of a new human life is a miracle regardless of the timing or place of conception, reducing conception to a laboratory procedure introduces possibilities for ethical problems. For example, not all of the newly formed embryos will develop into babies within a woman’s uterus. The embryologist may freeze some embryos for potential future development, discard others, and still others may become raw material for embryonic stem cell experiments. In addition, in vitro fertilization opens the door for the selection of an embryo with specific characteristics as well as the possible genetic manipulation of an embryo. While couples could use these approaches to select an embryo free from certain dreaded inborn diseases, a dark side of these technologies is the possibility of selecting offspring with certain physical, cognitive, or behavioral traits, reminiscent of eugenics.
Let us review several technologies in reproductive medicine and consider whether these technologies raise ethical concerns involving respect for the beginning of human life. For example, a couple may choose to have their sperm cells and egg cells frozen. A man who is about to undergo radiation or chemotherapy for cancer can have his sperm frozen to protect his ability to father children. Soldiers facing deployment to a war zone may also opt to freeze sperm to ensure future fertility.
Until recently, successfully freezing and thawing egg cells proved much more difficult. Human egg cells are the largest cells in the body — 10 to 15 times larger than other cells. There are several obstacles in freezing egg cells. Because of their size, egg cells contain more water than other cells. During the freezing process, destructive ice crystals can form within the eggs. Also, the genetic material in an egg cell is less stable than the genetic material within a fertilized egg (embryo). Furthermore, eggs do not fertilize well after thawing. The thawing process can disrupt the egg’s membrane interfering with the penetration of sperm through the egg surface.
Technology for thawing frozen eggs so they remain viable continues toward perfection.Embryologists are now using a flash-freezing technique known as vitrification to successfully freeze eggs.This allows women to preserve their fertility when they need to undergo chemotherapy.
Another way for women to preserve their fertility before undergoing chemotherapy is to freeze ovarian tissue and later have it transplanted back. After transplantation of ovarian tissue, egg cells develop naturally in the woman’s body with no need for in vitro fertilization. Since sperm cells, egg cells, and ovarian tissue are components of the patient’s own body, freezing these cells and tissue do not present the same ethical concerns as freezing embryos.
An embryologist can screen embryos created through in vitro fertilization using preimplantation genetic diagnosis.Doctors developed this procedure so couples at risk of having children with serious genetic disorders could increase their chances of having a child without that disorder.This procedure also enables doctors to analyze the genetic material of embryos before they implant these embryos in a woman’s uterus, permitting the selection of only healthy embryos for implantation.
PGD involves removing one or two cells from an eight-cell embryo and testing those cells for genetic conditions of interest to the parents. Using this technique, doctors can determine the sex of the embryos as well. Thus, couples at risk of passing on a genetic disorder that affects only males may choose to have a female baby.
Before the development of PGD — used in conjunction with IVF — couples may have chosen to have an abortion if prenatal testing showed that the fetus had a genetic disease. While reducing the number of abortions performed after prenatal testing is a positive aspect of PGD, the destruction of embryos found to have genetic defects continues to raise ethical concerns related to the sanctity of human life.
Another ethical concern is that embryologists may use PGD to screen for late onset adult diseases as well as fatal diseases of early childhood.In some cases, embryologists screen for a predisposition for a treatable disease that may not occur until after the fourth decade of life. PGD does not cure any disease; it merely prevents the patient who someday may develop the disease from ever being born.
An additional ethical concern is using PGD to select a child to serve as a tissue-match for a sibling. The concern is for the welfare of the donor child. Even though donating umbilical cord blood poses no harm to the donor, any future expectation for the tissue-matched child to continue to donate stem cells, tissue, or an organ to an ailing sibling would be an inappropriate burden to that child.
The use of PGD for nonmedical sex selection, such as family balancing, also has ethical implications. Even though couples may use nonmedical sex selection to achieve gender variety in most cases, certain cultures have a strong preference for male children. The availability of PGD for nonmedical sex selection could create a sex ratio imbalance within those cultures. Furthermore, some bioethicists feel that nonmedical sex selection opens the door for selection of other traits, leading to a view that children are commodities couples may choose because of their genetic attributes.
Another related technique used to screen embryos is preimplantation genetic screening, which involves screening for genetic abnormalities such as aneuploidy (an irregular number of chromosomes leading to conditions like Down syndrome or Turner syndrome). Embryologists use PGS to improve the success rates of IVF for specific groups of infertile patients such as older women, those with repeated IVF failure, or those with unexplained recurrent miscarriages. Such women are at increased risk of producing embryos with abnormal chromosomes. The aim of PGS is to improve the pregnancy rate and to reduce the risk of miscarriage for these women. A recent study in the New England Journal of Medicine, showed that women 35 to 41 years of age who underwent IVF along with PGS had lower pregnancy and live-birth rates — the opposite of the expected result.1 Thus, the effectiveness of PGS for women of advanced maternal age remains a matter of ongoing study and scientific debate.
Finally, techniques such as PGD, which are currently used for disease prevention, one day could be used for genetic enhancement, raising ethical questions about the rights of parents to design their descendents. In addition to mere selection of desired traits in offspring, genetic engineering of embryos remains a future theoretical possibility. Clearly, current and expected advances in reproductive medicine compel us to define appropriate boundaries to ensure respect for human life in its earliest stages.
Respecting the Marital Bond
Reproductive technologies raise ethical issues concerning not only respect for the beginnings of human life, but also respect for the marital bond between a husband and wife. The use of donor eggs, donor sperm, or a gestational surrogate mother brings a third party into the process of a husband and wife having a child.
Technology makes it possible to separate parenting into genetic, gestational, and social components. One or more of the genetic parents of the child could be different from the woman who will carry the child and different from the couple who will raise the child after the child is born. One or both of the genetic parents could possibly be deceased. It is theoretically possible for the genetic mother to have never been born, because embryologists can produce eggs from ovarian tissue extracted from aborted female fetuses.
For the Christian couple, there is wisdom in avoiding technologies that involve third parties contributing to the procreation process. Surrogate motherhood is at least as ancient as the biblical account of Abraham and Sarah who used Hagar, Sarah’s maidservant, to bear Abraham’s child. In this case, Hagar was both the genetic and gestational mother of Abraham’s son, Ishmael. No technology was involved. But the result of this arrangement brought conflict and pain for all involved. God’s grace, however, intervened to protect both Hagar and her son and to bless Abraham and Sarah. The story of Abraham and Sarah illustrates the potential relational problems of using a surrogate.
A recent development in surrogate motherhood is for couples to travel to India for infertility treatments and to select Indian women as surrogate mothers. The cost of surrogacy in India is about one-tenth the cost of surrogacy in the United States. The pay received by Indian surrogates is generous by local standards. The surrogacy fee is equal to about 10 times the annual per capita income in India. While it seems both the couple and the surrogate benefit from this arrangement, ethical concerns about avoiding potential exploitation of the women who agree to be surrogate mothers remain.
Another ethical concern in reproductive medicine involving respect for the marital bond between husband and wife is posthumous assisted reproduction. The birth of a child after the death of the child’s father always has been a possibility because of the 9-month delay between conception and birth.
Techniques for successfully freezing sperm, however, have made it possible for a man to conceive a child after his own death. Even though the idea of a wife desiring to have a child who will resemble the husband she has lost is understandable and having a child to carry on his line seems noble, Romans 7:2 makes clear that the marital bond dissolves at the death of one’s spouse. From a secular standpoint, ethical concerns surrounding posthumous assisted reproduction include establishing what constitutes informed consent on the part of the deceased spouse and defining the legal status of a child born under these circumstances.
Respecting the Needs of the Next Generation
The final criterion for establishing ethical boundaries in reproductive medicine is respect for the needs of the next generation. In the quest to help a childless couple have a biological child, doctors focus most of their attention on fulfilling the desires of the couple seeking treatment. Yet, it is vital that medical professionals keep in mind the best interest of the child being born.
For example, a child conceived with either sperm or egg cells from an anonymous donor may someday wish to access his own medical and genetic history. The Donor Sibling Registry, founded in 2001, has helped nearly 4,000 people who are genetically related — mostly half-brothers and half-sisters — find each other. The interest in this registry demonstrates that one ramification of anonymous sperm and egg donations is the creation of a person who someday might want to know the man or woman who contributed half of his genetic identity.
Reproductive medicine that respects the beginning of life, the marital bond, and the needs of the next generation can be a gift to infertile couples longing to have a child. New medical breakthroughs can be a provision of blessing when governed by appropriate guidelines.
Pastors can help couples understand the issues that define where to draw the ethical boundaries in reproductive medicine so couples will be better equipped to make informed decisions when seeking treatment. Similarly, pastors can help parishioners understand the principles that need to guide their response as a society to these new technologies. The church can provide a safe place for infertile couples to receive ministry as they determine God’s will for their lives and future families.
New technologies will appear on the horizon, but the principles that guide our application of those technologies are timeless. Equally timeless is the importance of upholding infertile couples in prayer. Remind them that God has a purpose for their lives that transcends their current struggles to start a family. May God provide you with the wisdom needed to minister to infertile couples under your care.
- S. Mastenbroek et al., “In Vitro Testing with Preimplantation Genetic Screening,” New England Journal of Medicine 357, no. 1 (2007): 9–17.