Christian reflection on Infertility and the ARTs - The Kirby Laing ...

What, if anything, should be done?For many infertile couples who previously wouldhave had little hope of having a child of their own,such techniques have made it possible to do so. Butat what cost? Many techniques raise troubling legalquestions concerning parental custody and contractsfor children. And moral questions aboundconcerning the treatment of human embryos, and thenature of marriage, procreation and parenting.It is not surprising that the debate surroundingARTs tends to focus on whether individualtechniques are morally (and legally) acceptable. Thisaspect of moral reasoning, called deliberation,concerns decisions about the means to achieve agiven end. With the wide array of remedies toovercome infertility and achieve procreation, it is anecessary part of thinking morally about ARTs thatwe subject them to careful deliberation.Yet while deliberation is necessary, it is not sufficientfor our thinking about infertility and ARTs. It is notsufficient because while the debate may shed lighton whether a particular technique (or ART as such)is morally acceptable, it does not speak to whether acouple should choose to pursue that means in orderto conceive a child. When the focus remains on whichmeans of achieving procreation is morallyacceptable, it may be implied that some such meansshould be pursued. Further, procreation (or perhapsindividual liberty) can easily be considered an almostunqualified good, blurring the edges of moraldeliberation and leading to a ready acceptance anddefence of questionable procedures.The significance of moral <strong>reflection</strong>Deliberation is an important aspect of moralreasoning, and yet it depends upon ‘a reflectivegrasp of some truth’. 4. Thus, in order to sustain,clarify or challenge the current deliberation aboutARTs, and to move the debate forward, it isnecessary to provide additional moral <strong>reflection</strong>, orto articulate it more clearly.There is a parallel in pastoral counselling. If theminister is to help an infertile couple seekingcounsel, it will not do first to direct their attention towhatever morally acceptable means are available toovercome infertility. This may be a necessary part ofthe counsel, but it is not sufficient, and it is not theplace to begin. Rather, the minister will do well toreflect with the couple about marriage, their desireto be parents, and their understanding ofchildlessness (since even the most aggressivetreatment fails to provide a child for many couples),and so on. Decisions about whether or not to pursueany treatment, and about which treatments aremorally acceptable, depend upon this type of prior<strong>reflection</strong>.In the debate about ARTs, it is necessary to makeexplicit some such <strong>reflection</strong> to guide and serve as afoundation for deliberation. Otherwise the moralframework can easily be reduced to an account ofprocreative liberty and the right to bear children. Afew comments about some central themes may behelpful.Marriage and its purposes. There is a growingtendency to understand marriage to be primarilyabout self-fulfilment, and to fit spousal relationshipsand even procreation into such a framework. 5 It isclearly inadequate. In Genesis 1 and 2, we seesomething of God’s intention for the relationship ofmale and female in marriage. Procreation is ablessing and a central purpose of marriage, whichhighlights the void created by infertility. Yetmarriage is also a partnership in a common callingthat is to be marked by covenant faithfulness in apermanent and exclusive one flesh union (cf. Matt.19:4-6; 1 Cor. 6:16; Eph. 5:31). Attention to theseaspects may at least put childlessness into properperspective.Parenthood. There is also a tendency to be consumedwith having a child who is biologically related, atleast to one parent. This desire ought not to beminimised, and certain techniques that allow amarried couple to have a child who is biologicallyrelated to both of them may be welcomed. Yet<strong>Christian</strong>s especially have good reason tounderstand parenthood in more than biologicalterms. 6We should be concerned about the lengths to whichsome will go to have a child ‘of one’s own’,including the use of ‘donor’ gametes and surrogacy,in which couples enter parenthood apart from theirone flesh union. An understanding of parentingbegins with the biological. Yet it is expandedthrough adoption, and further through parentalroles that can be assumed by those without children,including teaching and child care, as well as thesimple yet profound contribution of additional adultinfluence upon all children, especially those whoseown parents fail to provide the care that childrenneed.Childlessness. Literature on infertility has focused onunderscoring the pain of infertility, on overcoming

infertility, and on counselling childless couples. Allof these are important contributions, but perhapsthere is a need for further understanding ofchildlessness itself. For instance, we may understandthat a childless marriage is missing somethingsignificant, for marriage is intended to be procreative,yet it is not for that reason missing somethingessential to marriage. Such a marriage may beunfulfilled in some way (underscoring the void andpain left by childlessness), but it is not for that reasonincomplete. Nevertheless, for some, the option ofappropriate medical treatment for infertility will bereceived as a blessing, and it can be said that suchtreatments may be consistent with the gospel, andespecially with Jesus’ ministry of physical healing.For others, childlessness could open the way forpossibilities that the couple would not have initiallysought or embraced, which are derived from anunderstanding of the gospel.Implications of the gospel. 7 It must be said, first, thatultimate hope is not founded upon having children,but upon inclusion in God’s kingdom. The barrenwoman in Isaiah 54 and the eunuch in Isaiah 56 canrejoice because they are named among God’s peopleand may therefore be fruitful—even bearing many‘children’.Second, a childless couple, like the single person,may come to see their situation as an opportunity for‘undivided devotion to the Lord’ (1 Cor. 7:35; cf.Matt 19:12). Since ‘the appointed time has grownvery short’ and ‘the present form of this world ispassing away’ (1 Cor. 7:29, 31), childlessness mayallow a detachment from the usual patterns of lifeand a more focused investment for service in thekingdom of God. The Apostle Paul exemplifies thesepoints, for while he did not have physical children,he nevertheless begat many children in Christ,becoming their father through the gospel (1 Cor.4:15).Third, there may be a unique – even if unwelcome atfirst – opportunity to experience the grace of Godand of the community of believers that is notexperienced as deeply by those who are fullyinvested in their own children (cf. Mark 10:29-30;Matt. 12:46-50). Perhaps the childless couple willfind a Family – if the church is faithful to respond –that will share their burden, and discover afellowship of ‘brothers’, ‘sisters’, ‘mothers’, ‘fathers’,and ‘children’ that more than compensates for –though it does not replace – biological relatedness.These are some possible themes, and there areothers, that may be developed in biblical <strong>reflection</strong>on marriage and infertility in order to provide amore complete context for deliberation about ARTs.Such <strong>reflection</strong> on marriage and procreation and thesignificance of the gospel provides a moralframework that will give greater intelligibility to thequestion of means, and shape the deliberation in thedebate (whether or not our final conclusions change).Moral deliberation on ARTs revisitedA few brief guidelines concerning the use of ARTsmay be suggested in closing. Some of these arisedirectly out of the above <strong>reflection</strong>, while othersrequire additional <strong>reflection</strong> along slightly differentlines (such as <strong>reflection</strong> on an understanding ofhuman life and the status of the embryo). Beforeseeking a technological remedy for infertility,couples will do well to take some time to pray,reflect, and seek counsel. If they wish to proceed,they will also do well to decide in advance just whatthey will and will not do.Resistance of the technological imperative. Faced withthe painful reality of infertility, it is easy to treatARTs as almost unqualified goods. Further, the veryavailability and offer of ARTs can exert coercion,causing infertile couples to feel pressured to makeuse of them in the pursuit of the good of children. Itneeds to be said that there is no necessity for amarried couple to make use of even those ARTs thatare morally acceptable, for marriage has an integrityof its own and can be complete even without theexistence of children. The gospel can relieve couplesof any such burden.Children from one flesh. Couples who do feel led topursue infertility treatments may demonstrate theirpartnership in service to God and their sharing ofstrengths and weaknesses by a commitment tobecome parents only through their one flesh union.This suggests resisting the use of donor gametes or asurrogate. To anticipate a common objection, it maybe noted that these procedures are different fromadoption, in which the couple share an equalrelationship to the child, who is ‘redeemed’ from adifficult and existing situation.Treatment of human embryos. While this point requiresadditional <strong>reflection</strong> on the status of the embryo andwhat it means to be human, it is important to saysomething about it here, since it is central to thedebate about ARTs. We ought to resist proceduresthat involve great risk to or destruction of humanembryos, and instead affirm and protect the dignityof human life at its earliest stages. The desire toexperience the beauty of pregnancy and childbirth,

and to welcome new life as an extension of the love of marriage, ought not to be pursued in thecontext of the destruction of human life.ConclusionThe Bible does not minimise the sorrow experienced by those who are unable to have children, butrather resonates with it. Proverbs 30 declares that the barren womb is never satisfied, and yet thestories of barren women attest to the fact that the one who is barren is the object of God’s love. Thequestion is whether the church reflects the Bible’s sensitivity and concern for the childless. Theexperience of many infertile couples suggests otherwise: instead of comfort and encouragement,many have experienced insensitivity or even accusations of selfishness, from those unaware thatchildlessness is not chosen by many. As a remedy, Scripture challenges us to realise that no one inthe church is without family, for the church is Family, and it is to be a place of fellowship, comfort,and encouragement. Will the church take up the challenge?________________1. For a detailed description of various causes of infertility and the possible technological remedies, see Sandra L. Glahn and William R.Cutrer, The Infertility Companion: Hope and Help for Couples Facing Infertility (Grand Rapids, MI: Zondervan, 2004).2. Adapted by Gilbert Meilaender from actual cases in his essay entitled, ‘A Child of One’s Own: At What Price?’ In John F. Kilner, Paige C.Cunningham and W. David Hager, eds, The Reproduction Revolution: A <strong>Christian</strong> Appraisal of Sexuality, Reproductive Technologies, andthe Family (Grand Rapids, MI: Eerdmans, 2000), 36-45.3. In 2005, Adriana Iliescu made headlines as the oldest woman to give birth, at age 66, thanks to artificial insemination using both donorsperm and egg. ‘Romanian Woman Gives Birth at 66’, BBC online, Sunday, 16 January, 2005. http://news.bbc.co.uk/1/hi/world/europe/4179057.stm4. Oliver O’Donovan, ‘<strong>Christian</strong> Moral Reasoning.’ In David J. Atkinson and David H. Field, eds, New Dictionary of <strong>Christian</strong> Ethics andPastoral Theology (Leicester: IVP, 1995), 122.5. For some development and a critique of this tendency, see Christopher Ash, Marriage: Sex in the Service of God (Leicester, England:IVP, 2003).6. Cf. Stanley Hauerwas, Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church(Edinburgh: T & T Clark, 1986), 145.7. Among recent <strong>Christian</strong> ethicists, Hauerwas, as well as Meilaender to some degree, both mentioned already, have attempted to show thesignificance of the gospel for moral <strong>reflection</strong> on infertility and ARTs. Karl Barth is perhaps most explicit in his Church Dogmatics, III/4(Edinburgh: T & T Clark, 1961), 265-268.For further readingBrendan McCarthy, Fertility and Faith: The Ethics of Human Fertilization (IVP, 1997).Oliver O’Donovan, Begotten or Made? (Oxford University Press, 1998).Brent Waters, Reproductive Technology (Pilgrim Press, 2001).John F. Kilner, Paige C. Cunningham, and W. David Hager, eds, The Reproduction Revolution:A <strong>Christian</strong> Appraisal of Sexuality, Reproductive Technologies, and the Family (Eerdmans:2000).Dr Kenneth Magnuson is Associate Professor of <strong>Christian</strong> Ethics at Southern Seminary in Louisville,Kentucky. He received B.A. and M.Div. degrees from Bethel College and Seminary and aPh.D. from the University of Cambridge in Theology and Ethics. He has taught and written on sexuality,marriage and family, and bioethics, and is currently working on a project on Marriage, Infertilityand Assisted Reproductive Technologies. He is on the Board of Directors for The American Friendsof Tyndale House, Cambridge Inc.The Kirby Laing Institute for <strong>Christian</strong> Ethics,Tyndale House 36 Selwyn Gardens, Cambridge, CB3 9BA, UKT 01223 566619 F 01223 566608 E Ethics@Tyndale.cam.ac.ukThe Institute is an integral part of Tyndale House – the research division of the Universities and Colleges <strong>Christian</strong> Fellowship (UCCF), a company limited by guarantee,registered in England and Wales No 387932. Registered Charity No: 306137. Registered Office: 38 De Montfort Street Leicester, LE1 7GP.