Reconceiving Reproduction

Assessing Church Teaching and the Role of Conscience
An in vitro fertilization scientist inspects the microinjection of sperm into an egg cell (CNS photo/EPA)

In the musical Li’l Abner, a ragtag crew of townspeople develop a potent potion called “Yokumberry Tonic” that has the power to enhance the mind and body. The concoction is discovered and exploited by reproductive scientists from the “big city,” who hope to use it to improve society by enhancing human capabilities. In his memorable song “Oh Happy Day,” Dr. Rasmussen Finsdale dreams of the promise this tonic holds, envisioning a future of social conformity controlled by reproductive technicians in laboratories: “Oh, happy day, when miracles take place / And scientists control the human race, When we assume authority of human chromosomes / And assembly-line women / Conveyor-belt men / Settle down in push-button homes.”

Since its 1956 debut on Broadway, advances in reproductive technology have made Dr. Finsdale’s dream of “man-made man” a reality: in vitro fertilization (IVF) allows fertility specialists to produce and implant embryos; preimplantation genetic diagnosis (PGD) enables doctors to select particular embryos to avoid passing on genetic abnormalities during IVF; and advancements in gene-editing technology like CRISPR-Cas 9 suggest that our ability to influence the genetic makeup of future generations will soon balloon. This is only the beginning: soon enough, we will able to engineer not only conception, but also gestation. Early forays into artificial womb technology have put gestation outside the human body within reach.

Decades ago, in vitro fertilization technology was met with considerable apprehension. Dr. Finsdale’s cartoonish optimism and eugenicist tendencies caricature the worst possibilities for this technology. Comparisons to Aldous Huxley’s Brave New World abounded; double-helix-discoverer James Watson famously predicted “all hell will break loose” if there were to be a successful embryo transplant. Half a century later, we can safely say that Watson’s dire warnings of political and moral chaos were incorrect. When Louise Brown, the first “test-tube baby” was born in 1978, she seemed like a miracle, one in a million. Now, forty years later, she is just one amongst millions: over 1 million babies have been born through IVF in the United States since 1985 (when the U.S. Society for Assisted Reproductive Technology started keeping track), and it is estimated that there have been over 8 million babies born through IVF globally in the past forty years. Michelle Obama recently captured national attention when she revealed that Malia and Sasha were conceived via IVF. While rates of infertility (which the Centers for Disease Control and Prevention define as the inability to get pregnant after one year of trying) remain stagnant, the utilization of technologies like in vitro fertilization has surged, and with it, many infertile couples have been able to have children.

The reductionist rhetoric of the American prolife movement, which casts reproductive choices as either for life or against it, is ill-equipped to evaluate a procedure like IVF.

Despite the rapid development and increasing use of reproductive technologies, the Catholic Church’s moral teaching on the subject has developed very little in the past forty years. Louise Brown is not the only one celebrating a birthday: the instruction Dignitas personae (“On Certain Bioethical Questions”) was released ten years ago. This relatively short instruction from the Congregation for the Doctrine of the Faith (CDF) reiterated the church’s case against assisted reproductive technologies (including IVF) in the lengthier 1987 instruction Donum vitae (“on Respect for Human Life in Its Origin and on the Dignity of Procreation”), but with a few key updates that respond to technological developments from the previous decades. Both documents lay out the church’s logic for finding IVF and artificial insemination morally illicit. The CDF’s reasoning follows from the same principle that grounds the church’s argument against contraception in Humanae vitae. According to the CDF, the marital act contains two aspects, the procreative and the unitive, which correspond to the procreative and unitive ends of marriage. These aspects are inseparable, not only within a marriage, but as Pope Paul VI famously decided, within each instance of the conjugal act. For this reason, birth control (which frustrates the end of procreation) is illicit; IVF effects procreation without the physical union of the spouses. The fact that many IVF procedures include the abuse or destruction of embryos provides further reason for the CDF to oppose it––but even if care were taken to avoid elimination of excess embryos, the inseparability principle remains as grounds for objection.

It is common knowledge that most American Catholics find the church’s teaching on contraception less than compelling, so it may come as no surprise that only 13 percent of Catholics characterized IVF as “morally wrong” in a 2013 Pew survey. (This is virtually the same proportion as the general population: just 12 percent of Americans consider IVF to be morally wrong.) By contrast, 53 percent of Catholics in the same survey believe abortion to be morally wrong. While the irrelevance of church teaching on contraception might help explain some of this discrepancy, the difference in opinion among Catholics regarding IVF and abortion is striking given that the typical rationale for opposing abortion—the destruction of embryos—is frequently a part of IVF procedures. Typically, embryos that appear healthiest are selected for implantation to maximize the chances of a successful implantation and pregnancy, and the excess embryos are discarded, destroyed, donated for research, or frozen for potential later use. Sometimes, selective reduction is used to eliminate a fetus or fetuses during the first trimester of pregnancy to minimize risk associated with being pregnant with multiple fetuses. Given that there are obvious threats to embryos in many cases of IVF, it is all the more surprising that prolife Catholics do not oppose it more vocally. In fact, in a 2005 piece for Commonweal, Paul Lauritzen wondered whether IVF would be the “next big battleground” for prolife advocates. So far, this has not proven true: for example, a quick search on the popular prolife website LifesiteNews turns up only 554 results for “in vitro fertilization,” compared to over 38,000 results for “abortion.”

Why has IVF slipped under the prolife radar? It may be because many American Catholics are not familiar enough with the process of IVF, or aware of its widespread use. Let me suggest a secondary reason: the identity of the prolife movement centers around a valuing of human life—especially (and sometimes exclusively) in its most vulnerable nascent stage. People opting for abortions are accused of devaluing life, of prioritizing convenience or bodily autonomy at the expense of a commitment to human dignity. The few Catholics that do vocally oppose contraception bemoan the lack of openness to life that they perceive in the use of artificial contraception. In both cases, an intention to avoid or stop pregnancy is equated with being “anti-life.” Obviously, it is harder to make this case with individuals and couples utilizing IVF: Can you really accuse someone trying to get pregnant of being against life?

The reductionist rhetoric of the American prolife movement, which casts reproductive choices as either for life or against it, is ill-equipped to evaluate a procedure like IVF. Clearly, whatever moral guidance American Catholics are receiving is not resonating: 46 percent of American Catholics believe that IVF is not even a “moral issue.” Even if we set aside the inseparability principle, IVF and the technological innovations used in conjunction with it present a host of moral quandaries that have the potential to both promote and undermine life. On the one hand, IVF is literally life-giving, allowing individuals and couples to conceive when they might not be able to otherwise. On the other hand, IVF produces many embryos at once, all potential children, which are at risk of being commodified or otherwise treated instrumentally.

The process of IVF presents a variety of morally complex decisions for potential parents. With the help of fertility specialists, individuals and couples must decide how many embryos to create, what kind of testing will be done, and what to do with any excess embryos. Recent advancements in preimplantation genetic diagnosis (PGD) have only added to the moral burden of IVF. PGD has made it possible to select embryos that don’t carry certain genetic diseases over embryos that do, and to select embryos that carry lower genetic risk of developing certain cancers. We might imagine a variety of moral responses to this technology: some might oppose all variations of embryo selection on the grounds that it violates human dignity; others might draw the line differently, seeing the avoidance of genetic disease as morally acceptable while opposing selection based on risk of disease. Caution must be raised here about the potential for this technology—when used to avoid implantation of embryos with particular disabilities—to promote a culture that others those with disabilities and suggests that disability makes life not worth living.

IVF requires potential parents to decide the moral status of an embryo, an issue on which many prefer to remain agnostic. For example, when dealing with excess embryos that they do not want to implant, many using IVF equivocate, not wanting to destroy the embryos they have imagined as their future children, but not wanting to implant them either. In response to this predicament, many opt to delay decision via cryopreservation; the National Embryo Donation Center estimates that there are currently 700,000 to 1 million excess embryos frozen in the United States.

Even before embryos are created, individuals and couples must decide whether to use their own gametes (if that’s an option) or those of a donor. For same-sex couples, a donor is inevitably involved. Bringing a third person (and sometimes a fourth, if there are donors for both gametes) into one’s reproductive efforts adds additional questions to the process: Is it morally acceptable to involve a donor in the process? What characteristics should one consider when choosing a donor? What about involving a surrogate? Soon, the artificial womb may be an alternative to surrogacy, which will bring new ethical considerations.

The church’s teaching does offer moral guidance on many of these questions: in its reflection on the danger of treating children as products and its reminder of our human limitations, Donum vitae identifies some of the vital considerations in reproductive ethics. But any nuance found in Donum vitae is overwhelmed by the magisterium’s condemnation of IVF, which frustrates its attempts to provide relevant moral guidance to lay Catholics. And indeed, the fact that more than half of American Catholics see IVF as either not a moral issue or as morally acceptable suggests that this teaching is falling on deaf ears. Perhaps this is because, as Catholic moral theologian Margaret Farley has suggested, the teaching of the church on reproductive issues fails to respond to the lived experience of the laity. What would a pastoral response to Catholic individuals and couples using IVF look like?

The final document of the recent Synod on Young People (currently available only in Italian) suggests a way forward. This document acknowledges the rapid developments in biomedical technologies and the ethical and anthropological questions emerging from these innovations. It proposes three commitments that could help the church to recapture the attention of American Catholics: the importance of conscience, the meaning of accompaniment, and the role of social engagement.

The synod emphasizes attentiveness to one’s own conscience as a fundamental means of moral discernment. In the sanctuary of our own conscience, we encounter Christ intimately and learn to listen to God’s word, which in turn guides our moral choices. The document identifies the need for proper conscience formation, emphasizing that the development of the conscience is not limited to the clergy, but rather requires the assistance of a diversity of mentors, especially women. A renewed effort to facilitate conscience formation among Catholics and to connect Catholics making reproductive choices with experienced mentors and resources for reflection would aid the church in responding to new technological developments in biomedicine.

In order to respond to the challenges faced by the laity, the church first has to listen to the experiences of lay Catholics.

The reflection that one undertakes in the sanctuary of conscience is mirrored in the communal reflection in the sanctuary of the church. Thus, the process of conscience formation is not just about individual reflection; it requires the church to serve in an accompanying role, another theme that emerges from the synod document. The document mentions in particular the importance of accompanying those who have a vocation to marriage, which frequently includes having children. Given the pervasiveness of involuntary childlessness and infertility, the church’s liturgical life should make an effort to reflect the experiences of its people. The Archdiocese of Baltimore recently began a “Holy Innocents” ministry to support families who have experienced miscarriage. Similar initiatives could provide support for those struggling to conceive, especially in liturgical contexts that tend to honor parenthood without acknowledging the involuntarily childless. The church also has a responsibility to accompany children conceived via reproductive technologies. Given the ubiquity of these technologies today, how many young Catholics hear from the church that the manner in which they were conceived is morally illicit?

The synod’s final document recognizes that young people today are particularly socially engaged. While some American Catholics engage in robust advocacy on the issue of abortion, there are wider social implications to consider regarding reproductive technologies. These moral considerations are not limited to individuals, couples, and families; they also have an impact on the common good. Not only are there widespread disparities in access to fertility treatments (including reproductive technologies like IVF), both within the United States and globally, there are also issues of disability and gender discrimination that emerge in the use of reproductive technologies. In China, for example, abortion of female fetuses (in the hopes of having a male child in the next pregnancy) became such a problem that the government outlawed the use of ultrasounds to determine fetal sex. A thriving underground ultrasound business has sprouted in response. On the global level, “reproductive tourism” remains an urgent issue, particularly cross-border surrogacy. Frequently, impoverished women from countries including Thailand, Ukraine, and Nepal are sought out as gestational surrogates for wealthier Western couples or individuals at a rate cheaper than the cost of surrogacy in the United States (where it is only legal in some states). These social ills are opportunities for the church to exercise its prophetic witness and to engage young people as they cultivate their consciences.

In order to respond to the challenges faced by the laity, the church first has to listen to the experiences of lay Catholics. In the synod document, the “Synodal Church” is defined as a “Church of listening,” what Pope Francis called “the apostolate of the ear.” As the church works to renew its response to the laity, and particularly to young people, listening and accompanying should be the priority rather than moral prescriptions. As Pope Francis concludes, “May the Lord bless our steps, so that we can listen to young people, be their neighbors, and bear witness before them to Jesus, the joy of our lives.”

Emma McDonald is a student at Yale Divinity School and an editorial intern at Commonweal. 

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