This is the second part of a two-part series on the U.S. Bishops' new document on reproductive technology, Life-Giving Love in an Age of Technology, issued on November 17. In the first essay I discussed the document's ethical framework for analyzing particular forms of reproductive assistance. In this essay I review the document's ethical teaching on the following forms: using gamete donors, surrogate motherhood, homologous artificial insemination, in vitro fertilization, and cloning. Each consideration is brief. If interest is expressed, I'd be happy to develop one or another of the arguments in a future blast.
"Gametes" are sex cells - egg and sperm cells. Because some couples have problems with their own gamete production (e.g., men with low sperm count or whose sperm lack virility; or women who are older and hence more susceptible to birth defects if they use their own eggs), they secure gametes from other people in order to create a baby. This is morally problematic for several reasons. The parents intentionally create a child outside of marital intercourse; they create a child who is biologically not their own; and they include a third party within their choice to procreate. In so doing they violate the rights of the child, who (recall from my last blast) deserves in justice to be brought into the world in the context of an act of self-giving love by his or her parents. And they act against the good of their marriage by violating the unitive exclusivity that their marital commitment entails, analogous to the way extramarital intercourse violates marital exclusivity (i.e., adultery violates marriage's sexual exclusivity; donor gamete reproduction violates its procreative exclusivity). This follows from the truth that spousal unity (which entails its exclusivity) and procreativity are really two intrinsic dimensions of the one good of marriage. Intentionally violating either always harms the marriage as well as any offspring that may be brought about by such wrongful choices.
Surrogate mothers agree in advance to have another couple's embryonic child transferred into their wombs and to carry the child to term. In this way, gestating a child becomes a commodity analogous to paying someone to shovel your driveway or paint your house. The surrogate renders a service of utility that is either repugnant to the couple or impossible for them to fulfill. In contracting with a surrogate, both the married couple and the surrogate do wrong. The surrogate formally cooperates in the injustice of bringing a child into the world outside of marital intercourse; so it is not only the couple but also the surrogate who commits an injustice against the child. And the spouses violate both the procreative and unitive goods of their marriage, procreative because their child is not the fruit of their married love, and unitive because they should only ever procreate in the context of becoming "one flesh." The bishops also criticize fertility clinics for facilitating the immoral choices of young men and women by offering them large cash incentives to 'donate' their sperm and eggs. This is particularly risky for women who after they consent are given dangerous and powerful stimulants to cause them to produce multiple eggs at one time, rather than a single egg over the course of a monthly cycle: "The cash incentives persuade [them] … to jeopardize their own health in the egg extraction process, in the effort to help others obtain a child outside the context of their own marital relationship."
"Homologous" simply means "of the same evolutionary origin". In AIH a couple creates a child using their own gametes, hence the term "homologous". The woman is inseminated not by marital intercourse but by a syringe with her male partner's sperm. The sperm is usually procured unethically through masturbation. Here again the couple do an injustice to their child by depriving him of the fully personal context he deserves in his origins. As the bishops teach: "Children have a right to be conceived by the act that expresses and embodies their parents' self-giving love."
The bishops set forth an important principle for analyzing the morality of techniques in the field of reproductive medicine: techniques that assist the marital act in achieving its proper reproductive end are in principle legitimate; techniques that substitute for the marital act are not. For example, a technique that assists the marital act is called Low Tubal Ovum Transfer (LTOT). Due to blocked, damaged, or diseased fallopian tubes, a woman's egg sometimes cannot reach the sperm where fertilization can occur. To overcome this problem, a procedure was developed whereby a woman's egg after ovulation is relocated below the point of damage. This is done before or after marital intercourse depending on the most optimal conditions for fertilization to take place. We can see how this assists the married couple's intercourse in achieving a pregnancy. AIH, on the other hand, requires no act of intercourse at all.
During IVF, semen is procured from a male usually through masturbation and "washed" (which means centrifuged to separate the sperm cells from the seminal fluid). Female gametes are procured from a woman through use of drugs to hyperstimulate the ovaries (e.g., Clomid, Pergonal, Metrodin). Oocytes are retrieved by ultrasound-guided transvaginal aspiration. Sperm and egg are mixed together in a Petri-dish and several eggs are fertilized. Embryos are examined and ones that exhibit defects are destroyed. Healthy embryos are grown for approximately two days to the four-to-eight cell stage. Two to four embryos are then transferred either into the woman's uterus, or more rarely, into her fallopian tubes. Excess embryos are routinely frozen and earmarked for various purposes by the persons who made them (including for future pregnancies, embryo-destructive research, donation to other patients, or simple destruction). IVF can be homologous (i.e., using the wife's oocyte and husband's sperm), or heterologous (i.e., using the woman's oocyte and a donor's sperm). It may or may not involve surrogacy (as defined above).
I addressed in some detail in my last essay reasons for rejecting IVF as morally wrong, principally, because the new life does not come into the world as fruit supervening upon a self-giving act of marital love, but as the object of an act of production. In this way a child is depersonalized at his most vulnerable stage of existence. This is a grave injustice to the child, as well as a violation of the good of marriage.
Cloning, also called somatic cell nuclear transfer (SCNT), involves transferring the nucleus of a somatic cell ("body cell," from the Gk. soma - "body") into an enucleated oocyte (i.e., an egg cell with its nucleus removed). The somatic cell nucleus contains the complete genetic code of its donor. When it is transferred into the oocyte, the cytoplasm of the egg reprograms the nucleus back to an embryonic 'state' (called "totipotency"). It is reasonable to conclude that upon reaching this state, the cell becomes an embryo. It is then stimulated to begin cell division. The dividing embryo is genetically identical with the donor of the somatic cell (the Bishops call the embryo "a sort of delayed identical twin"). This technique renders superfluous to human reproduction the need for any male gamete (sperm), as well as a female gamete insofar as an egg with no nucleus is not a gamete but rather a sac of cytoplasm.
The most widely accepted form of human cloning is deceptively referred to as "therapeutic cloning" (deceptive because the technique is anything but 'therapeutic' to the cloned embryo). Its purpose is to create an embryo with the genetic identity of the donor of the somatic cell in order to harvest stem cells from the embryo at approximately day five in a lethal procedure called "disaggregation." The tiny embryo is thus created as a sort of 'stem cell incubator'; and he is killed when his stem cells are ripe.
The bishops teach that "in the act of being created not for his or her own sake but as a 'copy' of someone else, he or she is treated as a thing or even a commodity, not as a person. This is a gross violation of human dignity." An even grosser violation is to create the embryo in order to kill him. And the grossest violation, of course, is actually killing him for his stem cells.
Having taught on the wrongness of several procedures, the Bishops address a question that may be on the minds of couples suffering from infertility: "Must we abandon hope of conceiving a child?" Without discussing any possibility in detail, the Bishops mention options such as "hormonal treatment," "conventional or laser surgery to repair damaged or blocked fallopian tubes," and "means for alleviating male infertility factors" that do not replace the marital act. They specifically recommend the "techniques of natural family planning (NFP)" which can assist couples in maximizing their chances of conceiving.
The Bishops end the document by reminding married couples who cannot have children that their marriage is still meaningful and can still fulfill its "full Christian purpose." Although all couples are called to remain open to God's gift of new life, no one can assure the gift will be received. When it is not, a couple's suffering can be intense. The whole Church therefore should receive such couples with "sympathy and support". The Bishops conclude with a beautiful statement by Pope John Paul II to infertile couples: "to couples who cannot have children of their own I say: you are no less loved by God; your love for each other is complete and fruitful when it is open to others, to the needs of the apostolate, to the needs of the poor, to the needs of orphans, to the needs of the world" (Homily at Mass for families, Onitsha, Nigeria, February 13, 1982).