Arthur L. Greil is associate professor of sociology at Alfred university, Alfred New York.
This article appeared in the Christian Century, January 4-11, 1989. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at http://www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
As medical knowledge about infertility has increased, the ethics of reproduction is no longer the sole concern of the church.
The controversial "Baby M" case and the recent Vatican document on "respect for human life and its origins" have prompted many in the religious world to face the ethical issues raised by the new reproductive technologies. Our understanding of the relationship between sex and procreation has been challenged by heretofore unimagined methods of reproduction. The emotional needs of parishioners who are eager to have children and have no hope other than these new procedures have also forced theologians to re-examine traditional doctrines.
On March 10, 1987, the Vatican’s Congregation for the Doctrine of the Faith issued its "Instruction on Respect for Human Life in Its Origins and on the Dignity of Procreation: Replies to Certain Questions of the Day," which expressed the Vatican’s moral opposition to such practices as in vitro fertilization (IVF) , artificial insemination by donor (AID), surrogate motherhood, embryo freezing, and artificial insemination by husband (AIH) when semen is collected through masturbation. The instruction did not represent a change in the Vatican’s position. In 1949, Pope Pius XII expressed opposition to both AIH and AID, and in 1982 Vatican radio condemned IVF as a venture "into the realm of immorality." The instruction was clearly attempting to influence the choices of infertile couples and to encourage a public call for government restrictions on reproductive technology.
On March 31, 1987, Judge Harvey R. Sorkow of the New Jersey Superior Court awarded custody of "Baby M" to the child’s biological father and stripped her biological surrogate mother of all parental rights. In making this decision, Sorkow declared legal the practice of surrogate motherhood and of surrogacy contracts. Since then, the New Jersey Supreme Court has reversed Sorkow’s decision, declaring surrogacy contracts in violation of New Jersey adoption law but allowing Baby M’s biological father to retain custody. Surrogacy contracts are also illegal in Michigan and Louisiana, but several other states have passed legislation permitting such contracts.
Reproductive technology raises the question of whether it is proper for science to interfere with natural reproduction. Jerry Falwell argues against surrogacy on the grounds that "God’s way is still the best way." The Vatican instruction argues that reproductive technology tempts man "to go beyond the limits of a reasonable dominion over nature." Taken to their logical extreme, however, these arguments would lead to the rejection of all types of medical treatment for infertility. (It should be noted that the Vatican instruction does not oppose the use of fertility drugs or surgical measures to diagnose and treat infertility.) Certain Jewish writers, in contrast, take the opposite tack and argue that people have a moral obligation to take all reasonable steps necessary to preserve reproductive health.
Another pertinent ethical question is whether it is morally right to subject potential parents and unborn infants to treatments whose long-term effects cannot possibly be known. The late Paul Ramsey, writing from a Protestant perspective, argued that IVF entails substantial health risks to the future baby and must therefore be rejected. In response, Priscilla and William Neaves argue in "Moral Dimensions of In Vitro Fertilization" (Perkins Journal, Winter 1986) that the risk of having an abnormal child is no greater with IVF than with natural conception. People who "object to IVF for this reason should find natural conception equally objectionable," they say. Surrogacy also raises ethical concerns about health risks to the biological mother. Some Jewish theologians have opposed surrogacy on the grounds that because giving birth puts a woman’s life in danger, she should not take the risk of childbirth unless she will enjoy the benefit of keeping the child.
Some ethicists object to reproductive technology on the grounds that it is immoral to spend time and resources on extraordinary means of promoting births when attention should be devoted to preventing unwanted births and improving the health of all infants. Others suggest that reproductive technology and the concern with infertility promotes an idolatrous view of parenthood that values genetic parenthood more than the act of nurturing a child. While recognizing this danger, Janet McDowell in "Ethical Implications of In Vitro Fertilization" (The Christian Century, October 19, 1983) argues that this attitude is no more common among IVF couples than among those able to conceive normally. Finally, some claim that reproductive technology will promote a perception of children as products rather than as human beings to be cherished in their own right.
sufficient that the spheres be held together, so that there is no procreation apart from marriage, and no full sexual intimacy apart from a context of responsibility for procreation.
Though orthodox Jewish opinion rejects masturbation, it supports AIH if no other method causes the wife to become pregnant and there has been a reasonable waiting period after marriage. Some fundamentalist Protestants who have addressed the issue do not oppose artificial insemination within the context of marriage.
Treatments that involve laboratory collection of genetic material (AIH, AID and IVF) raise questions about the appropriate use of such materials. Treatments like IVF, which involve the creation of a human embryo outside the womb or the removal of an embryo from the womb, raise questions about the moral status of the embryo and its rights. Can it be destroyed or experimented upon? Who will look out for its interests? The Vatican instruction condemns both the freezing of human embryos and nontherapeutic experimentation on human embryos. While not all religious leaders would rule out experimental use of embryos, most believe that human genetic material should be used only under limited conditions. The Vatican and some fundamentalist Protestants view the discarding of extra embryos as abortion. But most religious commentators believe that the best response to this problem is to see that reproductive technology is regulated, not banned.
Treatments that introduce genetic material from a third party (e.g., AID, ovum transfer, surrogacy) raise other questions. Does this technology violate the exclusiveness of marriage? What are the moral and legal rights and obligations of the contributor of genetic material? What are the emotional ramifications for the couple when only one partner is the biological parent?
Even theologically liberal Catholics are inclined to agree with the Vatican that the use of third-party genetic material violates the sanctity of the marriage covenant. Some fundamentalist Protestants even deem it tantamount to adultery. Some Jewish theologians reject AID not because it could be construed as adultery -- they argue that it is extramarital sexual intercourse and not the use of the genetic materials of a third party that constitutes adultery -- but because it could result in inheritance problems and because a child with an unknown parentage may unwittingly commit incest. Reform Jews, arguing that the latter is quite unlikely, consider AID permissible.
Are male and female roles in creating offspring equal, and does the nurturer of a child have the same rights as the child’s progenitor? These issues arise when a woman gives birth on behalf of others, through surrogacy, for example, or some possible applications of IVF. Also significant is whether contracts and monetary arrangements should govern human reproduction. Orthodox Jewish theologians oppose surrogacy for this reason, as well as for the health risks it poses for the birth mother. On the other hand, some liberal rabbis see surrogacy as an acceptable option when all other methods have been exhausted. While opinion is by no means unanimous, most religious leaders reject surrogacy. The Vatican instruction’s arguments against AID apply here as well, and fundamentalist Protestants dismiss surrogacy straightforwardly.
This is what theologians and religious ethicists are saying about reproductive technology. But is anybody listening? Judging from statistics on patients at the P/F clinics on Catholic attitudes on other sexual issues, on the attitudes of the general public toward reproductive technology, and on qualitative research conducted by my colleagues and me, it appears that infertile couples are not heeding religious advice. Studies have found high levels of public support for reproductive technology -- sometimes as high as 90 percent for IVF and 20 to 60 percent for AID and surrogacy (though those who support it in theory may not necessarily choose it for themselves if they were to find themselves infertile and desired children)
Given Catholic teaching on the subject, we might expect infertile Catholic couples to be less likely to choose IVF and other reproductive technologies. But a New. York Times journalist who spoke to infertile Catholic couples after the release of the Vatican instruction found that while they were upset by the statement, they did not see it influencing their choice of treatment. Indeed, Catholic laypeople seem to feel quite free to depart from church teachings on issues related to sexuality -- a 1985 poll found that 73 percent of American Catholics believed that Catholics should be permitted to divorce and remarry; 68 percent approved of the use of artificial means of birth control; and 63 percent believed priests should be allowed to marry. Catholics will probably react similarly to Vatican positions on reproductive technology.
My interviews with infertile couples indicate that such indifference to religious objections is widely shared. For the couples I interviewed, practical concerns overshadow ethical concerns. These couples have one overriding goal: to become parents. They judge treatment options primarily on whether they are efficient and practical.
None of the couples were reconciled to childlessness. The one couple who had not pursued treatment at the time of the interview decided that it was time for the wife, at age 41, to begin an infertility work-up. No one who had stopped treatment mentioned ethical or religious reservations. Couples rejected treatment not because the next step was morally repugnant but because they were tired of the process or because they saw adoption as a faster means of realizing their goal.
The Vatican instruction calls upon infertile couples who have had no success with church-accepted treatment to find in their sterility "the occasion for other important services to the life of the human person; for example, adoption, various forms of educational work and assistance to other families and to poor or handicapped children." Most of the couples in my sample are more than willing to adopt, but would not find the Vatican’s other suggestions for coping with infertility very helpful. Infertile couples see infertility as an immense problem, but one to conquer, not one to become resigned to. Thus, they are not inclined to take the religious critique to heart. Reproductive technology, most notably the advent and acceptance of birth control, is in part responsible for this "do anything, try anything" attitude, and for the relative lack of attention to ethical and religious concerns. The couples I surveyed are part of the first generation to come of age in a time when birth control was widely available. They are the first generation to come of age believing in the myth of birth control -- that the human reproductive process can be controlled by technology.
Infertile women who pursue high-tech treatments are sometimes portrayed as victims of a societal belief that achieving motherhood is the only way to become "a real woman." The women in my sample were not necessarily "traditional," however. I found it was the less traditional women who were most likely to pursue treatment. They were shocked and demoralized when they realized that birth isn’t as controllable as they thought, but they remained committed to finding technical solutions to what they perceived, as medical problems.
Furthermore, infertile men and women today have some reasons for hope. Though some have likened the response of the infertile couple to childlessness to that of a person grieving over a death, the analogy between infertility and death is no longer accurate. Death is final and undeniable, but infertility is not. New treatments are constantly being developed, and some infertile couples conceive independent of treatment. Few couples are ever told that they have no chance to conceive. The open-ended nature of infertility is, to the infertile couple, a mixed blessing: though they can always hope to have a child, this hope makes it hard for them ever to resign themselves to infertility.
Whereas a woman could once say, "I must accept that bearing a child has been foreclosed," now she must consciously decide to stop treatment -- she must take responsibility for "giving up." Acceptance of one’s infertility has been transformed from an act of humble resignation to an act of selfish will. This attitude makes it exceedingly difficult for many couples to stop pursuing parenthood. Thus the treatment approach to infertility raises another ethical concern: Is it exploitative to offer expensive and often futile treatments to people desperate to have a child?
As medical knowledge about infertility has increased, the ethics of reproduction is no longer the concern solely of the church. When infertility was considered a predestined state, infertile couples were probably more influenced by religious interpretations. Appeals to moral rights and wrongs are less convincing when we believe we can change our condition through technical know-how. Accepting the Vatican instruction’s approach to infertility requires a spirit of resignation -- not a common spirit among couples pursuing infertility treatment.
Religious commentators’ objections to reproductive technology are not likely to have much influence on either the decisions of infertile couples or on the attitudes of the general public. Public policy is likely to reflect secular, ethical and legal concerns. This is not, however to say that religious leaders will not exert a powerful influence on the development of reproductive technology. Religious groups’ main influence will stem from their direct influence on medical protocols. For example, most IVF clinics implant all fertilized eggs in the uterus to avoid criticism from Catholic leaders and others who believe that allowing a fertilized egg to die is tantamount to abortion. I suspect that many Catholic hospitals will develop GIFT (gamete inter-fallopian transfer) clinics rather than IVF clinics, because GIFT seems to be more acceptable to the Vatican. (In this procedure, instead of mixing sperm and egg specimens in a petrie dish and then implanting the embryo in the mother, doctors surgically implant sperm into the mother’s fallopian tube, where fertilization would occur in natural conception. Ironically, Catholic leaders have supported GIFT by deeming it more "natural" than IVF, though the former requires monthly surgery and the latter none.) It is heartening to think that religious organizations will be able to shape medical practice in ways that will help infertile couples while avoiding some of the ethical difficulties that the new reproductive technologies present.