CHAPTER FOUR: Infertility and Assisted Reproduction
Thomas and Betty Muldoon were heartbroken. After eight years of
marriage and high hopes for a large, loving family, the Muldoons
were still childless. Six pregnancies were followed by six miscarriages.
And then the bleeding began. A tumor the size of a grapefruit was
removed from Betty's uterus. In the process, however, Betty ended
up receiving a complete hysterectomy, leaving only her ovaries.
Now they never would have children together.
But wait-an opportunity to make everything right again had been
dropped into their laps. Betty's favorite cousin, Kim, had offered
them the chance of a life-time. Using Tom's sperm and Betty's hyperovulated
eggs, fertilization could be achieved in a petri dish. The six to
eight embryos could be quick-frozen, and stored in the lab. Then
two or three of the embryos could be implanted, at just the right
time of the cycle, in Kim's uterus. The fetuses would grow, and
later on, if more than one was viable, the extra fetus(es) would
be removed. The remaining healthy fetus would grow to term in Kim's
body, and then would be given back to the Muldoons at delivery.
What a great opportunity to realize our dreams, thought Betty,
and how relatively simple. How sweet Kim was to offer her help in
this way. "Let's do it!" she urged Tom.
In the Easy Life Fertility Clinic the freezers were becoming full.
Todd Jenkins's job as lab supervisor was to find a way to store
more frozen embryos without raising clinic overhead. As he began
sorting through the stacks of records, he was surprised to note
how long some of the embryos had been in their custody.
Letters, phone calls, emails, telegrams, and even personal ads
in the city newspapers failed to locate many of the "parents".
Not to worry; the laboratory service agreement contracts were quite
explicit. Unclaimed embryos with rental fees more than two months
post-due were to be disposed of at the discretion of the clinic.
Todd looked up the telephone number for the local crematorium.
Business was business, and there was just no more room. Tomorrow
he would ship out the oldest thousand embryos for incineration.
With more coming in everyday, freezer space was at a premium.
Duchenne Muscular Dystrophy is an X-linked recessive inherited
disease. Joni Reinhard had watched her two brothers die before the
age of twenty-five. Genetic testing performed on Joni showed that
Joni was a carrier of the gene marker.
The doctor described a technique whereby the DMD status of the
fetus could be determined by ten weeks gestational age. Thus, if
the fetus was positive for the abnormal gene, Joni could choose
to abort, and not bring a Duchenne baby boy into the world. But
Joni was ambivalent about abortion. Wasn't there some other simpler
way?
Yes, the doctor explained. Dick Reinhard's sperm, obtained either
by masturbation, or captured in a condom during intercourse, could
be centrifuged. Using a special technique, the sperm with his X
chromosomes could be separated from those with his Y chromosomes.
His Y sperm could all be discarded, and only his Xs retained. These
X chromosome sperm, artificially inseminated into Joni, fertilizing
her eggs would produce only girls, who could be carriers but not
Duchenne children.
Thus, no one gets hurt, no fertilized eggs are discarded, and no
child will have to suffer with Duchenne Dystrophy.
In the last twenty years or so, reproductive medical science has
made astounding leaps forward. Some of these advances have been
primarily medical interventions, such as improved care for mothers
with diabetes, hypertension, and primary ovulatory failure. But
many of the advances involve what might be labeled "reproductive
technologies".
These include: 1) artificial insemination from husband or donor,
2) ova donation,
3) transfer techniques where eggs are placed with sperm inside or
outside the body, grown briefly and then assisted to implant, 4)
cloning-thus far (March, 2001), successful only in animals, 5) surrogate
motherhood, and 6) prenatal genetic screening. Each of these areas
would further include several variations on each of these themes.
(See reference.)
Historically, Protestant churches have had little to say about
any of this. The Roman Catholic Church, on the other hand, has had
a great deal to say. The Catholic Church has based much of their
teaching on "natural law", which is law based on careful
observation and reflection on creation, as opposed to revealed law,
seen in scripture. Thomas Aquinas, an influential natural law thinker,
summarized this position relative to procreation by stating that
every individual marital sexual act must be open to the idea of
creating new life. This, then, would forbid any form of contraception.
In 1968, Pope Paul VI clarified this in Humanae Vitae: On the Regulation
of Birth, an official Vatican encyclical. In 1987, "Instruction
of Respect for Human Life in Its Origin and on the Dignity of Procreation,"
further clarified the Vatican position. Any form of sexual expression
that separated the sexual union of the couple from the direct possibility
of pregnancy was to be shunned.
To illustrate, any form of permanent sterilization would be sinful,
as would any form of contraception, including the use of condoms-even
if the aim was to capture sperm for fertilization. (Some Catholics
fulfill the letter of the law by using a condom with a tiny pinhole
in it. This technically meets the Pope's dictum.) Sperm or egg donation
would be sinful. Surrogate motherhood was forbidden, as was cloning
and any type of prenatal genetic testing. There is some controversy
as to whether all forms of transfer would be wrong, but all agree
there would be very limited, if any, place for this.
Even within the Catholic Church, however, many feel that these
parameters are too strict. Certainly within Protestant Christianity,
the idea that all sexual activity must be open to creating new life
is not held to be true. While Protestants in general revere the
processes of procreation and sexual marital union, few would claim
that the two processes must always be linked.
Most conservative Protestants agree on the Christian's right, and
perhaps even obligation to plan one's family. Permanent sterilization
is a non-issue for most Protestants. Many would condone artificial
insemination with husband's sperm, or manipulations involving the
couple's own eggs and own sperm. The use of donor sperm or donor
eggs is more controversial. Surrogate motherhood would be deemed
highly problematic and general unacceptable.
Surrogate motherhood may include use of the surrogate's eggs and
uterus, or solely her uterus. In the case of the former, one can
easily see how she might come to see herself as the true mother,
and be unwilling or unable to give the child back to the biological
father and his wife. Even in the case of the latter, when a woman
carries a live human in her body for nine months, regardless of
where the genes come from, it may be extremely hard to surrender
the child on delivery. A number of ugly lawsuits have resulted from
surrogate arrangements, and most states now have laws that prohibit
or strictly regulate this process.
What does the Bible say about assisted reproduction? Let's look
and see.
Scripture and Discussion Questions
Genesis 1:27,28
Genesis 2:24
Matthew 19:3-9
Deuteronomy 25:5-10
Genesis 16:1-4a
1 Samuel 1:3-10, 27, 28
Luke 1:5-25
1) Some have quoted Genesis 1:27 as a command to all Christians
today to have as many children as possible. What does this passage
say to you?
2) Genesis 2:24 says that a man will leave his family to start
a new one. This was generally not the pattern of family life in
the Middle East. Do you see this as relevant to today? Please elaborate.
Does this verse apply to this lesson?
3) Jesus quotes Genesis in Matthew 19, and then explains this more
completely. How does the Genesis passage or Christ's explanation
bear on today's discussion?
4) Deuteronomy 25 describes a concept called Levirate marriage.
Does this concept have any bearing on today's discussion? Why or
why not? Do Old Testament laws have any purpose for our lives today?
(Note: there was no form of Social Security in Israel and many scholars
feel that this was a way of protecting the widow from destitution.)
5) Genesis 16 relates a story about a common practice of that day.
Genesis 30 relates a similar story. What do you think about these
events, and should we use these passages as templates for relationships
today? Why or Why not?
6) Hannah suffered the pain of childlessness. God chose to answer
her prayers. Are we to make promises to God to manipulate him into
giving us what we want? Is this an example of how we should act?
If not, why did God answer her prayers? Why does he choose not to
answer the prayers of many other childless couples?
7) Luke 1 tells Elizabeth's story. She says that God has "taken
away her disgrace" of childlessness. Is this a disgrace? Do
we treat this as if it was a disgrace? How can we be more sensitive
to those around us who may be feeling as if they are disgraced?
8) Can you think of other scriptures that would guide your thoughts
and actions through this complex discussion? Traditions? Experience?
9) How is the destruction of fertilized zygotes any different than
extermination of Jews and Gypsies in Nazi Germany?
10) Does the concept of polygamy have any bearing on discussion
of infertility and assisted reproduction? Does the Bible speak against
polygamy?
11) If you knew that your family carried a recessive trait for
a potentially painful, disability syndrome, would you feel morally
obligated to not conceive children? Discuss and role-play.
Comments
1) "Selective reduction" is a euphemism for the abortion
of the extra fetuses in utero, whose continued existence might decrease
the likelihood that the chosen fetus would survive and flourish.
The term "selective reduction" sounds benign, but is clearly
another form of abortion. Terminology is important in framing our
thoughts.
2) Many quick-frozen fertilized embryos exist throughout the world
in fertility clinics. Dr. James Dobson has aired several radio shows
emphasizing the plight of the stranded embryos. The Center of Bioethics
and Human Dignity and other groups have issued a call to prevent
the creation of more fertilized zygotes. (This could be a full day's
discussion all by itself.)
3) The name "Easy Life Fertility Clinic" is used to remind
readers that infertility is a source of untold hidden pain and suffering
throughout America and the world. Research efforts to relieve this
problem, however, may result in death and destruction of fertilized
embryos. Discuss an appropriate Christian response to these two
tough issues.
4) The Catholic Church, historically, has decried any separation
of the sexual act from the possibility of procreation. Thus, even
the act of masturbation to obtain sperm for in-vitro fertilization
would be deemed wrong, as would the use of a standard condom, even
when used by a married couple.
5) Contraceptive options have moral implications. Discuss the most
commonly used options and their bioethical implications. You may
need to obtain assistance from a Christian physician or scientist
to facilitate this discussion.
6) A number of bizarre legal cases have arisen from surrogate litigation.
See if you can find some examples to bring to class from articles
at your local library or from off the internet.
7) If you have time, role-play a surrogate agreement, and see if
you can capture all the possible emotions the surrogate mother,
the legal mother and the legal father might feel.
8) In today's first vignette, Betty thought that Kim's offer was
sweet and relatively simple. These types of arrangements are never
simple, and the long-term ramifications of this arrangement might
be even more complicated by keeping it within the family.
PRAYER REQUESTS
As you close today's lesson together, pray that God will help you
to be more sensitive to the pain of the childless in your midst.
Pray that God will give you wisdom to address these tough issues,
and the love and humility to support persons, if not their acts,
who may interpret scriptural principles differently that you do
where scripture does not clarify God's will completely.
For Further Reading:
Much of the information for this lesson comes from Scott B. Rae,
Brave New Families-Biblical Ethics and Reproductive Technologies
(Grand Rapids, Michigan: Baker Books, 1996). Dr. Rae scores again
with a readable, informative text-this one dedicated to reproductive
ethics.
John F. Kilner, Paige C. Cunningham, and W. David Hager, eds.,
The Reproduction Revolution-A Christian Appraisal of Sexuality,
Reproductive Technologies, and the Family (Grand Rapids, Michigan:
William B. Eerdmans Publishing Company, 2000).
This is a delightful collection of essays focusing on foundational
issues, specific technologies and difficult bioethical cases from
a Christian perspective. Chapters five through eight specifically
address technologies and will prove helpful to group leaders looking
for a more in-depth coverage of this week's topics.
Gary P. Stewart, D. Min., William R. Cutrer, M.D., Timothy J. Demy,
Th.D., Donal P. O'Mathuna, Ph.D., Paige C. Cunningham, J.D., John
F. Kilner, Ph.D., and Linda K. Bevington, M.A. Basic Questions on
Sexuality and Reproductive Technology-When is it Right to Intervene?
(Grand Rapids, Michigan: Kregel Publications, 1998). This is another
of the BioBasics Series, produced by The Center for Bioethics and
Human Dignity, in Bannockburn, Illinois. An easy evening's reading,
this booklet gives one a quick overview of a complicated field.
Robert D. Orr, MD, A Clinical Ethics Perspective on Assisted Reproductive
Technology, Ethics and Medicine-An International Christian Perspective
on Bioethics, (2000) 16: 2, 51-54. Dr. Orr, of Loma Linda University
Medical School, offers a concise Christian look at Assisted Reproductive
Technology.
Ronald Munson, Intervention and Reflection-Basic Issues in Medical
Ethics, 5th ed., (New York: Wadsworth Publishing Company, 1996).
Chapter eight provides a secular look at in vitro fertilization,
artificial insemination, and surrogate pregnancy. Dr. Munson tells
his stories through interesting historic case presentations, selected
readings and decision scenarios.
Stephen E. Lammers and Allen Verhey, eds., On Moral Medicine-Theological
Perspectives in Medical Ethics, 2d ed., (Grand Rapids, Michigan:
William B. Eerdmans Publishing Company, 1998). Chapter eleven, "Technological
Reproduction," offers six essays on this complicated topic.
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