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Saturday, January 22, 2005

Is in-vitro fertilization justifiable?

Tomorrow is Sanctity of Life Sunday, which culminates Sanctity of Life Week. It was established to encourage recognition of the fact that human life, from conception on, is to be protected. This year it falls one day past the anniversary of Roe vs. Wade.

The following is from a letter (edited) I recently sent to Focus on the Family.

Dear Focus on the Family,

I applaud you for speaking out on “life” issues and am encouraged by your support of the sanctity of life.

However, I am disturbed by something in the January issue of Focus on the Family magazine, in the “special feature” article by Carrie Gordon Earll entitled, “The Life Ethic.”

To begin her article, Earll lists examples of recent alarming news stories representative of the new biotechnical revolution. She follows with an assertion that human life is sacred. Says Earll, “A good baseline for testing the morality of bioethics is the sanctity of human life ethic, a non-negotiable view that human life, from fertilization to natural death, has intrinsic dignity and eternal worth.” (bold emphasis added) With this I wholeheartedly agree.

However, shortly thereafter, Earll brings up the subject of in-vitro fertilization (IVF). She calls it a “more complex example” (of a current life issue than abortion) and says, “while IVF may raise other ethical concerns, the goal is to enable couples to conceive a baby, not to destroy a human life.” She does not mention what these “other ethical concerns” may be.

While I do not contest that the goal of IVF is to conceive and not destroy, the fact remains that some of the created embryos, i.e., conceived babies, do not survive the process. Therefore, I must ask: Does the end (goal) justify the means?

It is a known fact that IVF results in embryonic demise, whether from failure to culture, failure to implant in the womb, or failure to survive cryo-preservation. Earll states that “The life ethic demands that no human embryo be intentionally destroyed or tampered with, so creating only the number of embryos that you intend to implant and allowing those to develop without manipulation reduces the risk that the life ethic will be violated.” (bold emphasis added)

The latter statement concedes that there is still a risk of violating the life ethic through IVF – if this is so, then how can IVF be justified? What is the risk? Is the risk acceptable?

If the life ethic demands that no human embryo be intentionally destroyed or tampered with, then IVF does not comply. IVF involves the intentional creation of embryos with the knowledge that some will likely perish in the IVF process. Though the embryonic deaths are inadvertent, they would not occur if the embryos had not been created in the first place. With IVF, the natural process of conception and implantation is artificially tampered with and manipulated to produce a pregnancy where one cannot naturally occur. This would not be a problem except that the process incurs a probability of embryonic demise greater than the naturally-occurring probability, since it adds man-made perils to naturally-occurring ones.

Surely then, during the IVF process, the non-negotiable view of the sanctity of human life is being negotiated. A couple who elects to undergo IVF does so with awareness of the fact that some of the embryos they help to create will perish.

Earll’s words appear to be evidence of compromise and rationalization.

Please note that I am in no way callous to the grief of couples who long to conceive children but are not able to do so naturally. However, personal desires and feelings should not determine ethics.

Obviously, any child born as result of IVF is every bit as valuable and precious as any other child. The problem is, those tiny lives which perish as a result of IVF are too.

I have no desire whatsoever to judge anyone who has undergone IVF, or who defends it. But I do think the issue should be discussed thoroughly, honestly, and consistently by those who claim, as I do, that human life begins at conception.

I welcome discussion.

18 Comments:

  • Hi - I have started a new aggregator for Christian women bloggers. I've added about 20 people to start it off. I'm not doing a blogroll as people have heaps already. All I ask is that people in it link to it. I added you. Could you email me and let me know if you want to be in (and have linked to it) or not? Here's the link:
    Women4God BlogsWe aren't well represented on the aggregators and this is a way for women to read each other and new bloggers to find other women. Once I've heard from the first group I'll open it up to everyone else to join. Thanks.
    My email is catez2003 AT yahoo DOT com

    By Blogger Catez, at 8:24 AM  

  • Hi there

    I discovered your site from the women4godblogs group. I appreciate your letter and I think it was very well-written both in the style and logic.

    peace,
    CG

    By Blogger Christie, at 11:33 PM  

  • For myself, I KNOW (with the data I know now -- I've heard horror stories about trying to adopt that make me realize it isn't quite as easy as one might wish to adopt in a culture where we kill so many of the unwanted children before they are born, and states play politics with the children that are not killed and released into the system) that I could not pursue IVF -- I'd rather foster and adopt.

    However...
    I think that your argument breaks down.

    If you've had 3 miscarriages (my cousin has) then doesn't the ethical standard of don't do anything that you know can cause a child to die mean stop having sex?

    I am perfectly okay in my head with those people who use technology to create no more fertilized embryos than they are willing to implant and bring to term -- and then implant them.
    I am also perfectly okay with extracting sperm and eggs and freezing them separately.

    If they are not intentionally killing children, then you have to leave the rest up to God. God can take our children both in the womb and outside of it, if it is his time.

    By Blogger My Boaz's Ruth, at 6:48 PM  

  • Hello Ruth,

    If you've had 3 miscarriages (my cousin has) then doesn't the ethical standard of don't do anything that you know can cause a child to die mean stop having sex?I think that's going a bit too far -- what does God say in Scripture about having sex? It's a basic thing that married people are supposed to do. Yes, God can and does take children in the womb; I've had a miscarriage, and a great number of my friends have as well.

    But that's different from man taking the process of creating a child outside of the sex act and introducting additional perils to the process, as I spelled out in the letter.

    By Blogger Bonnie, at 8:13 PM  

  • In your letter to FotF you argue that “If the life ethic demands that no human embryo be intentionally destroyed or tampered with, then IVF does not comply. IVF involves the intentional creation of embryos with the knowledge that some will likely perish in the IVF process.” I must point out that this is also true when you try it the old fashioned way. Almost 50% of pregnancies attempted by the tried and true method result in conceptions that are spontaneously aborted by the body within days or weeks, and often being sloughed off during the following menstrual cycle, going unnoticed by the mother. The reasons for this rejection are multiplex. So then, a couple who decides to have sex to create a child does so with the knowledge that some of those attempts will results in a spontaneous abortion, and yet, this method is not under critique even though the result is the same. I admire your stance, but in my own one-sided opinion, I believe your line of reasoning as outlined in your FotF letter requires some reconsideration. I myself am against the intentional destroying of IVF conceived embryos, and even though the transfers are expensive, were I ever to be faced with such a dilemma, I think I would opt to conceive and transfer one at a time, rather than in groups, so that each one would have a chance and none would be intentionally destroyed. That said transfer could be rejected by the body would be no different than if I tried the old fashioned way, which obviously wasn’t working or I wouldn’t have opted for IVF. Also, IVF can be a really promising option for women with debilitating endometriosis, since actually getting pregnant can help get rid of the scar tissue which causes the pain. Since the endometrial tissue prevents a woman from getting pregnant, IVF is sometimes the only option if drugs such as Lupron are ineffective. However, this is not a legitimate philosophical reason for defending IVF. All I am saying is that condemning IVF simply because transferred embryos may unintentionally die in the implantation process I don’t believe is a strong enough argument.

    By Blogger Neil, at 5:00 AM  

  • Neil, you couldn't be more wrong on this.

    I miscarried a baby at 23 weeks. I didn't intentionally kill it. I didn't intend for it to die, but God another plan. Being open to God's will for your life and the lives of your children (born and unborn) is what Christians are ultimately called to do.

    Sending them down the sink when cleaning the petri dish ON PURPOSE is totally different and frankly a little sickening that you even compare the two.

    By Blogger Elena, at 5:53 PM  

  • Neil,

    Thanks for taking the time to share your thoughts.

    In the comment above yours, I addressed the issue of natural, spontaneous miscarriage as opposed to additional peril introduced via intervention in the fertilization/implantation process.

    My objection to transferring even one embryo at a time is that several factors must be manipulated in the process – hormones must be administered to the woman to induce conditions for accepting an embryo, and the embryo is put into the womb in a manner that differs from the way it would naturally approach the womb (via the fallopian tubes.) These factors add a greater probability of implantation failure than exists naturally, as I mentioned in the letter. It is an additional risk (added to the natural risk), which threatens real, actual human lives.

    Also, in the mere creation of embryos in the lab, some die, and the embryos are often screened for potential viability. Since the conditions of the lab cannot match exactly the conditions inside the body, there is undoubtedly greater peril involved than exists in the body naturally. I think your percentage of 50% of natural pregnancies failing is a bit high...although the actual incidence is difficult to determine. But I don’t dispute the fact that it’s at least 25-30%. These failing occur without any direct interference on anyone’s part, however.

    Another thing that disturbs me is that, in seeking the services of a fertility clinic, one is supporting their business. This business may include objectionable practices such as multiple-embryo implantation and cryopreservation, genetic screening, etc. I realize that that’s a controversial (and perhaps more personal) reason to not support something, in and of itself, but for me, the idea of supporting those who view beginning life as something that can be manipulated is unsettling.

    By Blogger Bonnie, at 7:28 PM  

  • Elena, I think you misunderstood what I was saying. I'm not talking about the wilful discarding of an unwanted IVF embryo and I thought I was pretty clear about that. I'm talking about the frequent occurence of a TRANSFERRED IVF embryo not implanting and then being sloughed off by the body. There is no difference between this and the normal procreative act that also results in an embryo that doesn't implant, or become ectopic, etc. In each case the intent was to create life, and in each case, the body rejected it for whatever reason (including the Will of God). My point is that to say that just because some IVF transfers might not actually implant (when the intent is to do so) is not a very strong argument against IVF. There are other stronger arguments against IVF (like the wilful discarding of left-over embryos) than the one you've described. That's all. Cheers, Neil.

    By Blogger Neil, at 7:31 PM  

  • I apologize Neil, I did not read carefully enough. I defer to Bonnie's excellent reply just above yours which I totally agree with.

    By Blogger Elena, at 9:53 PM  

  • Hi again,

    I'm going to have to get back to you on some factual details (my fiancee is an OB/GYN, which is why this discussion interests me), but from what I recall, spontaneous miscarriages do in fact occur in about 50% or thereabouts of fertilizations.

    Another thing that disturbs me is that, in seeking the services of a fertility clinic, one is supporting their business.True, but not all of these services are performed in a "clinic" with questionable social points of view. Many are performed in a hospital.

    Also, in the mere creation of embryos in the lab, some die, and the embryos are often screened for potential viability. Since the conditions of the lab cannot match exactly the conditions inside the body, there is undoubtedly greater peril involved than exists in the body naturally.Well, if you were to overlay the bell curves of risk between natural conception and artificial conception it's possible the risk of death for a non-transferred embryo might be higher, but there is quite a bit of overlap between those two bell curves. All things being equal is IVF riskier to an embryo? Almost assuredly, but I'll have to find out distinct facts. All things being equal, if you take the least risky woman who takes care of herself and tries IVF, yes, it will be a riskier pregnancy. All things are never equal, however. Hordes of women eat too much sugar during their pregnancy, which can cause very serious problems, the least of which is a high birth weight, which triggers the need for a caesarian (which can kill a mother, with no other indicators as to why). This is a serious risk factor. But, I'm going to ask an REI specialist colleague of my fiancee's to double check some issues.

    There are quite a few other details I could go into about this, but the general idea I'm getting from both Bonnie and Elena is that it is the issue of external influence outside the womb that is bothersome to you both. Is this correct (in general, that is)?

    Me personally, I have no problem with external influence so to speak, because every choice we make about having children is "external influence" in one way or another. What we eat, drink, whether we exercise, stress levels, etc. And these things directly affect the embryo, but Christians aren't marching on Washington about whether or not a woman eats too much sugar. Recently researchers have found that what you eat, drink, etc. BEFORE you conceive (and this includes the male as well) is as important, if not more important that what you imbibe DURING pregnancy, affecting several birth characteristics as well as early complications, etc. These are wilful external choices which could have a huge bearing on whether or not an embryo is spontaneously miscarried or not. That there might be or is an "added" risk by IVF work is not enough to tip over the scales for me to say that IVF is therefore untenable. That unused embryos are discarded is very bothersome to me, but the mere generic technique of IVF is not.

    Something also to consider: it might be worthwhile for Christians to support IVF, but with stricter ethical guidelines, because that will evetually cause the medical/research community to come up with new techniques to create embryos that have the highest chance of surviving the dish and transplantation. Given restraints, human beings always find more creative ways of doing something. I personally would rather see more refined techniques of IVF created in response to strict ethical guidelines authored by Christians in the field, rather than a Christian disengagement from the research altogether. People will always take the path of least resistance, so if the resistance to unrefined, unethical methodology is high enough, human creativity will attempt to find a path that meets all the ethical requirements.

    I'm going to have to do a post on this. Thanks for the lively discussion. Cheers, Neil.

    By Blogger Neil, at 7:25 AM  

  • You seem to have two arguments, the one that IVF is riskier than natural conception and the one that IVF is less natural than natural conception. I'll leave aside the first one. I'm interested in how the second one is supposed to work given what you've said before about artificial contraception. In the past, you've resisted the argument (rightly in my view) that something is wrong merely because it is different from how it would naturally go. Otherwise natural family planning and artificial contraception would both be wrong, you argued (again, rightly in my view). I'm wonderering how this fits with your arguments that IVF is wrong merely because its methods are not following the natural course of things as designed by God.

    When Neil pressed you on this, you reverted to the risk of harm argument, which is a different argument. Do you simply not believe the natural purpose argument, or do you find a distinction between the kind of unnaturalness of AC and the kind of unnaturalness of IVF? The only thing I can think of is that you think it's wrong to do something unnatural in intending to conceive but not wrong in doing somethhing unnatural in preventing conception. I'm not sure what would motivate a moral difference between the two, though. Keep in mind that I'm not talking about the risk of harm argument here. That's a separate issue, as far as I can see. You could accept either argument without accepting the other.

    By Blogger Jeremy Pierce, at 9:30 PM  

  • Neil and Jeremy,

    Thanks so much for your participation in this discussion! I hope your comments haven’t been sitting too long; I forgot to check down here for a couple days.

    Neil: I would be very interested in links to studies, etc. supporting the specific information you are referring to regarding the influence of a mother’s diet on the health of the embryo. I was not aware that an embryo’s health was as specifically sensitive to a mother’s (or father’s) diet as you are stating. I’m not even sure how controlled studies could be done on such things that would produce conclusive results. Nor how the 50% natural miscarriage rate can be determined. But, I’m not a scientist.

    Jeremy: I do find a distinction between the unnaturalness of AC and the unnaturalness of IVF, which is that AC prevents gametes from meeting, i.e., creating a new life (most of the time) and IVF involves tampering with actual human lives after the gametes have met.

    My thinking regarding the difference between the separation of sex from babies as occurs with IVF as opposed to the way it occurs with AC/NFP relates to what I said in my comment on your “poop” post about purpose/design. It is the purpose-of-sex argument that I use to support use of contraception. A Catholic may argue that, by contracepting, one is killing, by prevention, one’s future children, yet clearly NFP can do the same thing via abstinence. So we are still stuck with the purpose argument. Is the purpose of sex to allow for gametes to meet if the sex occurs at a time of fertility? That’s what Elena would argue, as you know. I must then counter with, “is the purpose of sex to deny sex during times of fertility unless one deems the time to be right to allow for conception?”

    Elena’s view imparts a sort of holiness to the gametes themselves, and to the intrinsic integrity of the sex act itself, but disregards the holiness of the unitive purposes of sex apart from procreation.

    It seems to me that IVF creates a much larger separation between sex and procreation than does AC, since it separates intercourse from procreation entirely. But I suppose this could be argued against as well. Maybe another day :-)

    I know you were just concerned with what you called my 2nd argument, but I’ll address the “risk” argument as well:

    Actually, I don’t think my argument that IVF involves additional peril to the embryo equates with risk, precisely; it concerns artificial introduction of greater peril than exists naturally, i.e., something done by man as opposed to something done by God via His design. I suppose one could say that God does design for man to alter or manipulate His design as part of man’s call to stewardship of Creation, yet stewardship involves caretaking. There is no caretaking involved in bringing greater peril upon something than it would otherwise face. I don’t see the continuum of lifestyle influences to IVF procedures as they affect the embryo as clearly as Neil does. There are a myriad of factors and many unknowns, apparently, in knowledge of how lifestyle factors influence pregnancy. Although maybe I’m not up on the latest.

    My argument also concerns the willful introduction of greater peril, or, of carrying out a procedure with full knowledge of the likely peril. I think the morality of any action is determined by more than mere intention: the results, the final action, carries as much if not more weight. Inadvertent harm as result of good intention is not my concern; my concern is with the ignoring of known definite or likely ill effects of a course of action, regardless of intention, which is what it seems to me that IVF entails. Are parents undergoing IVF concerned with what may happen to each and every one of the human lives they create, or is this concern overridden by their desire to have a child?

    Whew, it's all quite complicated! Does any of this help?

    By Blogger Bonnie, at 3:03 PM  

  • Bonnie,

    I wonder what you would think if IVF was developed to the extent that it was actually less perilous than natural methods? Would that make natural methods objectionable, because there would be safer ways of conceiving? Or is your baseline that things shouldn't be any worse than you feel your god intended, but they don't have to be any better?

    By Blogger Paul, at 12:42 PM  

  • Hi Paul,

    IVF impacts more than just one area of moral concern, therefore I do not have just one "baseline" for my view. As long as IVF remains in-vitro, it will still separate sex from making babies.

    As to hypotheticals regarding peril reduction, let's figure out how to reduce peril first, then we'll examine its morality :-). Actually, in the case of infertility, there is no peril involved because conception cannot naturally take place. Therefore, the mere act of harvesting ova and introducing them to sperm creates a greater peril than would occur with no attempts at fertilization.

    By Blogger Bonnie, at 10:43 PM  

  • Thank you to neil and boaz's ruth first of all for walking in Love and Grace, which is what our Father God is.
    My husband and I have faced this issue in our own lives. We have been unsesseful in over 4 years of trying to concieve natrualy, and adoption (2 failed).
    We sought help to find why we were unable to get pregnant. The answer was my husband had almost no viable sperm and doctors told us it would be inpossibe to concieve. The first doctor told us to use donor sperm- this was not an option for us! THe 2nd doctor said he could help us but with how low his sperm count was it would have to be IVF.
    We are a couple who kissed for the first time when we were engaged and waited to you know until married. My husband was my first kiss ever and we took natrual family planning classes because we believe that the pill was preventing Gods blessings and it does not keep the sperm from meeting the egg it terminates after conception.
    I said all that so you understand the kind of people that are faced with these choices!My husband is the 3rd generation of Pastors in his famly and I am as well, an ordained minister. Although our hearts are for the orphans and we have traveled lots taking care of them. And hoping adoptions will come through eventually for us we decided with much peace that we would go ahead with ivf.
    We are hoping to hear those long awhited words' you are going to be parents" next week when we go in for test.
    We were very clear on our wishes, and the paperwork is extensive when it comes to the wishes of what your desire is for the care of your embryos, which we are thankful. If you have not been faced with this in your own life- I would not be to quite to judge! LIFE is precious! And it is in the Lords hands if it is a miscarige in the womb or in an incubator.It is still a loss. We are only hoping he has finally blessed us with the gift of LIFE! After so much loss!

    By Anonymous Anonymous, at 4:09 PM  

  • Next time you get a nasty infection, go with God's plan and forgo the antibiotics.

    By Anonymous Anonymous, at 10:19 PM  

  • Not going to be able to dodge Paul's question in perpetuity. IVF will become a less perilous process in our lifetimes much the same way treating chronic disease with modern medicine is more efficient than letting your body do it the 'natural' way. Further, infertility takes on many forms. A woman who miscarries many times without a successful pregnancy may well have an anatomic issue causing the difficulty. In her case, IVF potentially represents a less perilous attempt at having a child. By your measure, if this woman continued to get pregnant via intercourse hoping for a different outcome, her decision would be less moral than IVF which is the point Paul attempted to make.

    By Anonymous Anonymous, at 10:43 PM  

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