A Christian Worldview Response to Current Bioethical Issues (Part Three)
At the Beginning of Life
In this third part of my attempt to articulate a Christian response to current bioethical issues, I focus on some of the challenges associated with the beginning of life. From the innumerable issues, I have chosen to address challenges associated with in vitro fertilization, surrogacy, and prenatal diagnosis. Mentioning some texts from Genesis and the relevance of other biblical materials provides guidance for appropriate analysis of these hypothetical cases.
A Christian and biblical worldview provides context and content for coping with life, disease, and death. Our context is life as children of the Creator; our content and guidance is His revelation in our nature and in Scripture. Life is valuable, since people are created in God’s image; but not an absolute value, to be preserved always and at all costs. Though Christians can affirm that God is our Healer, people are not always immediately healed of all diseases or injuries. Because people live with the struggles of life as well as its blessings, Christians should always show God’s mercy to others (cf. Pack Sufficient Evidence Spring 2014, 3-15). Those who live life informed by God’s nature and His guidance bring an important contribution to current bioethical issues—a perspective shaped by the revelation of the Creator‘s own patient, merciful plan. As we noted in Part Two (Pack Sufficient Evidence Fall 2014, 87-94), Christian health care professionals have special opportunities to share their perspective on life’s blessings and struggles.
Today, Americans are pressed by society to accept what is described as a woman’s right to choose. However, many Christians view such choice as an inappropriate response to life in the womb.1 Dr. Andre Hellegers, an obstetrician and founding director of Georgetown University’s Kennedy Institute for Ethics, supported dignity for developing human life saying:
The first definition of life, then, could be the ability to reproduce oneself, and this the fertilized egg has while the individual ovum and sperm do not. This newly fertilized egg, sometimes called a zygote, has within it the hereditary characteristics of the father and the mother, one half from each. [Describing the processes of fetal development, Hellegers adds] the understanding of the processes described is the understanding of today. [Then, comments:] it is not a function of science to prove, or disprove, where in this process human life begins. In the ultimate analysis the question is not just to forecast when life begins, but rather: How should one behave when one does not know whether dignity is or is not present in the fetus?2
A 2014 National Public Radio broadcast indicated that technological capabilities have significantly changed since Hellegers’ observations in 1970.3 The story was about mitochondrial defects in vitro and modifications using third party subcellular materials. DNA transplants to remediate inherited defects in a fertilized ovum might be called microsurgery on a fertilized egg. However, these changes do not require one to ignore what Hellegers called “the first definition of life.” Dignity and respect for the humanity of such zygotes, for human life at the stage where there is an “ability to reproduce oneself,” allow Christians to become strong proponents of the value of respectfully preserving human life—even damaged or “defective” life.
Hypothetical Cases for Analysis
Case #1: A pregnant woman had blood work at her doctor’s office. A low alpha feto protein (AFP) blood level indicated the potential for Down’s syndrome. Following an ultrasound, the physician discussed amniocentesis with the patient. It is explained that this procedure is now safer than ever before and will provide her with vital information.
In such a brief account, teasing out the moral perspective or possible biases of the case writer is certainly not easy. However, many who might present this issue in America today do have an agenda. The case description claims that this is “vital” information, and the ambiguity of that term might indicate some bias or agenda on the part of the physician. Some assume that a Down (or Down’s) syndrome fetus should not be carried to term. Terminating a pregnancy is the expected and recommended action if Down syndrome, trisomy 21, is the prenatal diagnosis. Christians would, and should, be troubled by this assumption and expectation. Life is valuable, and biblical guidance concerning human reproduction (cf. Genesis 1:28) does not come with conditions limiting the “multiplying” or “increase” to whole and healthy lives.
In an interview with Bob Schieffer, aired on CBS Face the Nation February 19, 2012, Rick Santorum made the claim that 90% of Down syndrome children are aborted. Apparently, this claim came from an English study published in 1999 in Psychology and Genetics (though their claim was 92% and did not refer to American studies). Becky Bowers and Louis Jacobson (politifact.com Feb 27 2012) gave Santorum’s comment a “half- truth” rating based on further research. Bowers and Jacobson report a conversation with Mark I. Evans, physician and President of the Fetal Medicine Foundation of America, who told them that local studies in America do produce such data reporting 80-90% abortion rates after a trisomy 21 diagnosis. However, Evans also told them that there has been no national study to justify claims about American abortion rates and that other local studies report abortion rates as low as 10%.
Maternal blood tests and routine ultrasound monitoring are currently considered part of best practice for prenatal care in the United States. It is typical for additional tests to be recommended if abnormalities are detected. Thus, discussion of amniocentesis as mentioned in Case #1 is to be expected. Amniocentesis (testing some amniotic fluid) has been used in medical practice for more than a hundred years, and in the 1950s prenatal diagnosis of some disorders like Down syndrome became possible. Full chromosomal analysis began in the 1970s, and adding improved ultrasound technologies led to significantly lower risk of miscarriage (cf. Stein).
A Christian response to this case does not demand either a refusal of amniocentesis or a termination of the pregnancy. Some women, who would not choose to terminate their pregnancy, might feel that amniocentesis is unnecessary (even though risks are lower now). Other women might want to proceed with this test or other tests to prepare for care of a special-needs child.4
Normality and physical well being are important in the modern world, but that was true of the ancient world and biblical eras, as well. While being lame, even in both feet, is certainly not comparable to Down syndrome in any precise way, such conditions certainly brought difficulty to life in the ancient world. The account of David’s kindness to Saul’s grandson, Mephibosheth (2 Samuel 9), provides just one reminder, out of many elsewhere in Scripture, that those who are disadvantaged still deserve someone to speak up for them (cf. Proverbs 31:8-9).
Case #2: A childless couple concerned with the complications of in vitro fertilization (IVF) and with eggs that are not viable, decide to find a surrogate mother who would bear a child for them. A fertility clinic helps them find a woman willing to be fertilized with his sperm and agreeable to carry the child to term for compensation and care. She signs a contract to give up custody of the child upon birth. Later, the surrogate changes her mind and wants custody.
The Bible is full of stories telling of children as a blessing from God. Christians understand the emotional struggles that come with childlessness. The dramatic story of barrenness and childbearing is told well in the biblical texts about Jacob’s wives and children (Genesis 29:31-35:18). It was truly a blessing to bear children, and much sadness came with childlessness. Another of such indications is found in the story of Hannah who was distressed and prayed to the LORD because she was childless (1 Samuel 1:9). She wept bitterly and would not eat, troubling her husband deeply (1 Samuel 1:8). When the LORD answered her prayer, she named her son “Samuel” (meaning “I have asked him from the LORD”; 1 Samuel 1:20). In the New Testament, Luke tells the story of Zechariah and Elizabeth. Though they were both righteous before God, they had no child since Elizabeth was barren (Luke 1:5-7). However, Zechariah’s prayer had been heard by God, and an angel of the Lord told him that Elizabeth would bear a son who should be called John (Luke 1:13). Such biblical accounts highlight God’s compassion and mercy and provide examples to Christians about how we can extend such mercy to those around us.
Case #2, technological intervention in reproduction, has become commonplace in the modern world. However, such an approach may have unintended consequences. Children may be put in awkward legal situations. Courts may demand that a surrogate mother share custody or at least be involved directly in a child’s life. This child is biologically related to the father (sperm donor), but is not biologically related to her mother since her eggs were not viable. Similar surrogacy cases are matters of record in legal settings during recent decades.
William and Elizabeth Stern signed a surrogacy agreement with Mary Beth Whitehead leading to the birth of Baby M on March 27, 1986. Whitehead was inseminated with William Stern’s sperm and contracted to relinquish her parental rights in favor of Elizabeth Stern. After the birth of Baby M, Whitehead decided to keep the child. The Sterns sued to be recognized as the child’s legal parents in New Jersey in the late 1980s (In re Baby M, 537 A.2d 1227, 109 N.J. 396). While the court ruled that the surrogacy contract was invalid, custody was awarded to William Stern.
In California another surrogacy contract became a problem when Mark and Crispina Calvert made an agreement with Anna Johnson for her to bear their child. Mark Calvert’s sperm and Crispina Calvert’s egg were fertilized in vitro. The resulting embryo was implanted in Johnson who decided to keep the child she gave birth to. In Johnson v Calvert (851 P.2d 776 Cal.1993), the judicial ruling determined that the Calverts were the child’s genetic, biological, and natural father and mother. Johnson was even denied visitation rights. What made this case different from the Baby M case was that the surrogate had no genetic relation to the child. Both cases indicate how surrogate arrangements can go wrong. Other cases, types of cases, and complications include matters like sperm/ovum donation or IVF children who want or need to know their genetic parentage.
Perhaps surprising to some today, the Bible addresses many of the emotions and complications somewhat similar to the modern cases of surrogacy and/or offering reproductive assistance. For example, Abram (who became Abraham) was promised a son to be his heir, but impatience and attempts to create an alternate plan brought unfaithfulness and pain, more pain than the delayed blessing of having the promised son (Genesis 15:4-5; 16; 17:16- 19). Sarah offered her handmaiden, and Ishmael was born to Abram and Hagar. Eventually God would bring Isaac to Abraham and Sarah, but Hagar and Ishmael suffered greatly. Some might say that much of the turmoil in the Middle East would not exist, except for this ancient plan for surrogacy. Similar, tragic choices were made in Jacob’s family (alluded to above in the reference to Genesis 29-35). Though Jacob, Leah, Rachel, and the handmaidens (Bilhah and Zilpah) did not face quite the consequences that came to Abraham, Sarah, and Hagar. Nevertheless, Jacob’s family choices also varied from life as God had planned it.
The depths of “who is the rightful mother” of a child are seen in the case of two women who appeared before King Solomon hoping to resolve an issue of infant death, survival, and motherhood (1 Kings 3:16-28). Sometimes it takes the wisdom of Solomon and the wisdom of God to sort out the complications people can introduce into the issues of childbearing and parenthood.
Jesus made it quite clear that God’s plan for husbands and wives should be as it was in the beginning—one man and one woman in a relationship of marriage (Matthew 19:4-5). God’s plan for bringing children into the world focuses on that same relationship (Genesis 1:28; 2:24). When we modify God’s plan, Christians know that unnecessary difficulties are the likely outcome.
Case #3: A couple desperately desiring to have a child of their own have struggled to conceive. They decide to have some of her eggs harvested for insemination with his sperm. Planning carefully, they sign legal documents protecting the embryos and requiring consent of both gamete donors before any action can be taken with the embryos.
The couple is excited to discover that their physicians have been able to assist them with conception and successfully bring a child into their family. Not all the embryos were used, however; and their happy family does not remain tranquil for long. After the man and woman end their relationship, he wants to make sure the remaining embryos are not left frozen. He wants additional children, his children. She is unwilling to consent to the use of their embryos so that he can have more children.
Making human life has a broader range of meaning in modern times. Reproduction has sometimes become a technological process since Louise Brown was born in 1978 in England, the first “test tube baby” (more accurately in vitro fertilization baby, i.e. IVF). This process typically involves manual fertilization of several eggs (ova) in a petri dish. These can be transferred to a woman’s uterus. Generally, several other fertilized eggs are frozen (cryopreserved) for future use. Fertilized ova may die in the thawing process, be discarded, or used for research.
In taking the technological approach, people often misunderstand the process. Many embryos are created; only 1 or 2 are usually implanted at a time in hopes of a resulting pregnancy. If the first implantation is successful, the excess embryos remain frozen for an indeterminate amount of time. Will the couple ever want all the embryos to become children, or will they become unwanted (“orphans”) because the parents did not think about the consequences of their decisions? A key word in this case account is the term desperate. Yes, some who are childless feel desperate to have children. Society demands a level of compassion for such desperate people that would allow almost any intervention in order for them to have a child. Thus, fertility clinics and technological approaches to impregnation appear unquestionably justified to many.
When one begins to examine Case #3 more carefully, it becomes obvious that there are more stakeholders here than just a mother, a father, and a child (or children) brought to life with the assistance of IVF. Frozen embryos remain viable, and some of us would claim that those unborn babies have much at stake whether they ever become conscious of it or not. The father clearly has interests of which he seemed unaware when the first child was conceived. The mother also has interests that may not have occurred to her in those desperate childless days. She does not want the un-implanted embryos to become what everyone will regard as babies growing up to be children. At least, she does not want their father to be allowed to see them brought to birth. The couple became an estranged couple with different and unanticipated perspectives about what to do with the as yet un-implanted embryos that, to the father, represent his unborn children.
In this case there had been an attempt to assure that neither of the parents nor anyone else could do anything with or to the embryos created for their family through IVF. However, their planning failed to anticipate the interest one parent might have to pursue implantation of the embryos even after the parents became estranged.
According to Ray Strom: “The Society for Assisted Reproduction says that 165,172 IVF procedures took place in 2012, resulting in 61,740 babies—both U.S. records” (“Frozen Embryos: Who Do They Belong to?” chicagolawyermagazine.com 14 May 2014). Strom adds that the number of frozen embryos is estimated in the hundreds of thousands, perhaps up to 1 million.
Though sperm donation and assisted reproduction long preceded IVF and is a significantly different procedure, some issues with technologically assisted reproduction overlap. In the 1940s and 1950s, British biologist Bertold Wiesner and his wife, Dr. Mary Barton, assisted many infertile families to conceive. By the time the clinic closed in the 1960s, the Wiesners had assisted couples to produce some 1500 children. Wiesner’s own sperm was used for many of the procedures, allowing him to father between 300 and 600 children. The British government now outlaws his practice of secretly using his own sperm, and there are now limits on the number of families that can receive sperm from the same donor. Records for the Barton clinic were destroyed before Dr. Barton’s death in the early 1980s (Randy Kreider. “Did Sperm Bank Founder Father 600 Children? abcnews.go.com April 9 2012).
Offspring of technologically assisted reproduction must be better protected. American and British attitudes and laws have not kept pace with the complications being introduced. That was true for artificial insemination by donor, and it is true for in vitro fertilization procedures. Society presses for acceptance of such efforts to assist, but Christians must speak out about unforeseen and unintended (potential) harms that may come to the children and their families.
Christians should have concern for orphans and it seems appropriate for them to make their opinion known that parenting is more than a modern technological phenomenon. Sperm donation and frozen embryos should be a part of Christian social concerns. Caring for orphans and widows may have a broader meaning in the contemporary world, but such care is still a part of pure and undefiled religion (James 1:27).
Some Further Biblical Guidance
For the Christian, discussions about the beginning of life should start with God and include the Scriptures. Genesis 1-5 reports the creation of the world, creation of human life both male and female, God’s call for human reproduction, sexual desire, pains of childbirth, blessings of parenthood, and so much more that might be characterized as parameters of a Christian worldview with regard to the beginning of life. One insight gained from these early chapters of the Bible is that God intended for humans to “subdue and have dominion” over the rest of creation. Perhaps, some of the greatest possibilities in modern medicine are part of God’s plan for people to affect the Earth and each other in positive ways. Medical technology and innovation may be part of God’s good gifts to us, if we do not let such technology surpass or dominate biblical theology.
Other texts within Genesis provide additional insight. For example, Noah and his family were reminded of the preciousness of life, especially human life made in the image of God (Genesis 9:1-7). They were given guidance about the value of life in respect to slaughtered animals and their blood, but were told emphatically that people who kill other people should not be allowed to live. In the context of moral choices at the beginning of life, such a lesson may not immediately seem relevant. However, Amos 1:13 reveals that life and prenatal life must always be respected. When trying to extend their borders, even the Edomites, who were without the Law of Moses, were expected to know that it was wrong to slaughter pregnant women and their babies. In a modern context of terrorism and wars that focus on ethnic cleansing, God’s message about the value of life is still relevant.
Many biblical texts beyond the first book of the Bible provide guidance to shape our response to these issues. In this particular journal it seems most appropriate to share nuggets of insight from Thomas B. Warren, not because he is our authority, but because he often encouraged a return to faith in God and His word. Warren began a 1991 article on “The Christian Ethic” with the words: “The Christian ethic is a revealed—not a speculative ethic” (315), citing texts like 2 Timothy 3:16-17; 2 Peter 1:20-21; 1 Corinthians 2:9-13; John 10:35; 17:1; Matthew 5:17-19. Christian responses to ethical issues must include biblical perspectives alongside other reasons and explanations we might offer. We must be clear and faithful, as Jesus said: “Let your communication be Yea, yea; Nay, nay” (Matthew 5:37).
While standing for truth, Christians can let the mercy of God shine through. As the apostle Paul explained, we can grow more Christ-like teaching the truth with love (Ephesians 4:15). Warren also realized that responding to questions about sensitive moral issues requires mercy and kindness:
It is possible for one to self-righteously evaluate himself as a truly great moral person while he gives no thought to the fact that he is neither merciful nor kind to his own family, to his brothers and sisters in Christ, and to other people. However, the Bible greatly stresses the ethic of mercy and kindness (Acts 20:35; Rom. 12:15; 15:1-5; Gal. 6:1-10; et al.). (320)
For Christians it is truly important to remember to be merciful. Mercy is crucial in the hypothetical cases discussed above and, more importantly, in real-life situations. Christians must remember biblical lessons about compassion. We must remember mercy whether we are dealing with the grief of childlessness, mistakes made in terms of adultery or surrogacy, or with complications introduced into the life of parents or children. Throughout the history recorded in Scripture, God tolerated things He did not approve, and protected innocents where He could do so without eliminating the possibility of human free will
Conclusion
God intended for human life as He created it to be continued in the relation of a man and a woman to one another. Families were intended as part of God’s plan for human blessings. Perhaps that is part of the reason that His Son Jesus came into the world as part of Mary and Joseph’s family. The dignity of the unborn was part of the life of Jesus and his cousin John, Elizabeth and Zechariah’s promised son. Medical technology has its place, sometimes even in wonderful ways touching the life of our children. Christians should, however, remember that there is something very special about caring for orphans. Our grief over childlessness can and should be handled carefully and prayerfully. Helping other families with children is good. We might also remember that at times adoption can be a better way to address some issues at the beginning of life. We must not allow ourselves to be over- absorbed in the answers of modern medicine and technology. We must not use these technological blessings in ways that counter God’s original plan for life and procreation.
Works Cited
Stein, Rob. “Your Health: Combining the DNA of Three People Raises Ethical Questions.” National Public Radio. 10 November 2014.
Warren, Thomas B. “The Christian Ethic.” Biblical Ethics: The Sixth Annual Shenandoah Lectures. Ed. Terry M. Hightower. San Antonio: Shenandoah Church of Christ, 1991.
Notes
1 Vincent Barry (Bioethics in a Cultural Context. Wadsworth. Boston: 2012. Chapter Three 57-73) recently proposed that the context of modern bioethics began in a 1969 Boston workshop that resulted in publication of a 1970 newsprint edition of Our Bodies, Ourselves (OBOS appeared in 1971 with this title and subsequently republished in several editions. See “History” @ “Our Bodies, Our Selves: Information Inspires Action,” ourbodiesourselves.org. 12 May 2015). Barry also observed that the twentieth century enhanced medical technologies, at the beginning and at the end of life, set the context for what came to be called “bioethics.” Others might tell the story a different way, setting the primary discussions and participants in a different locale, but that radical changes in the discussion of ethics in medical practice seemed to begin at or around 1970 seems commonly accepted especially in regard to the beginning and end of human life (Recent discussions in places like Wikipedia have tied the actual term “bioethics” to earlier usage. See “Bioethics,” Wikipedia. 12 May 2015).
2 Hellegers, Andre E. “Fetal Development.” Theological Studies 31 (March 1970): 3-9; reprinted in Tom L. Beauchamp and LeRoy Walters, Contemporary Issues in Bioethics, 3rd edition, Wadsworth, Belmont, CA: 1982. 125-129. It was here, from Hellegers, that I learned that twinning in humans could occur until the fourteenth day after conception and that in these first few days twins or triplets may recombine into one single individual. Though the early studies of such “chimeras” were conducted with mice, by 1970 six human cases had been identified based on the diagnostic karyotype XX-XY.
3 (See journalofethics.ama-assn.org 12 May 2015 for an article by Maura Parker Quinlan, MD, MPH. “Amniocentesis: Indications and Risks” Virtual Mentor 10 (May 2008): 304-06.).
4 Other prenatal tests, besides amniocentesis, might also be recommended. Chorionic villi (CVS) testing that takes tissue from the placenta at about 9 weeks has a slightly higher risk than amniocentesis. Percutaneous umbilical cord sampling may also be offered at or about 12 weeks into the pregnancy. For more information see americanpregnancy. org, last updated Jan 2014; and see also ghr.nlm.nih.gov reviewed Nov 2013 and published May 11 2015.
See also Casey Fiano’s “90% of Babies Diagnosed with Down Syndrome Are Aborted, One Abortion Activist Wants More,” an opinion piece published at LifeNews.com July 30, 2014. Fiano is responding to Chelsea Hoffman’s comments on Sarah Terzo’s attempt to expose “abhorrent treatment” some parents receive when they are told of a positive diagnosis of Down syndrome. Fiano mentions a study associated with Harvard University done by Dr. Brian Skotko at Massachusetts General Hospital. Skotko found that “women routinely received negative, outdated information” when given a Down syndrome diagnosis. Information like this has led many Down syndrome advocates to encourage passage of laws mandating up-to-date and accurate information. Fiano commends the FirstCall program that gives new parents an opportunity to be connected with a family of a child with Down syndrome.
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Rolland W. Pack earned the M.A. degree in Christian Doctrine from Harding University and earned the Ph.D. in Philosophy with an emphasis in medical ethics from Georgetown University. He was a research and teaching fellow of the Kennedy Institute for Ethics while at Georgetown. The former Professor of Philosophy and Biblical Studies at Freed-Hardeman University was also Dean of the Honors College and Associate Vice President. Dr. Pack is 2014-15 Visiting Professor of Philosophy at Heritage Christian University. He may be reached at Rolland.Pack@gmail.com.