assisted reproductive technology: progress or peril?

Assisted Reproductive

Technology:

Progress or Peril?

Ashley K. Fernandes, MD, PhDWright State University School of Medicine, Dayton, Ohio

Earl K. Fernandes, STD, MdivMt. St. Mary’s Seminary, Cincinnati, Ohio

Blessed are they who did not see, and yet believed. (John 20:29)

Purpose

To outline the science and philosophy behind a pro-life position on Assisted Reproductive Technology (ART)

To show that the philosophy behind the Catholic Church’s view is something reasonable

To answer some common objections to this view along the way

What This Talk Is

An acknowledgment of brotherly help!

A brief outline of the epidemiology and science of some assisted reproductive techniques (ARTs)

An articulation of the ethical and social problems involved in ART

A decidedly Catholic-Christian enterprise—no apologies! (except in the Greek sense)

Dr. Fernandes

Fr. Fernandes

What This Talk is NOT

An apology (except in the Greek sense!)

A defense of Christianity itself

An attempt to present all arguments in favor of, or against, ART

A “bashing” of the proponents or users of ART

Christ and the Apostles, Domitilla Catacombs, Rome (4th cent.)

In the Image of God

“…is central to the identity of every man and woman. This identity consists in the capacity to live in truth and love…the need of truth and love as an essential dimension of the life of the person.”

--John Paul II, Letter to Families (1994)

The Human Person

In his reflections on the family, John Paul II sees the family as a communio personarum, bound in love

The fundamental unit of value is the human person

But what is his nature?

The Human Person

‘Extrapolations of science’s materialist premises produces a bioethics measured by the good of the body or the species, for that is all there is. Mind, soul, emotion, spirit—all are simply epiphenomena of mater…There is no reality beyond what we can touch, see, feel, or smell.’

--Edmund Pellegrino, describing the positivist-empiricist model

The Christian personalist model

A person is an individual substance of a rational nature (persona est rationalis naturae individua substantia)

A person is a being created in the image and likeness of God

The positivist-empiricist model

The Right to Truth and Love Individualism

People are free to decide for themselves what to do with their bodies and themselves

Caring is non-interference with the desires of another

The obliteration of the person as one who thinks, acts, loves, and lives in community with another

Personalism Freedom transcends choice

(actus hominis) Freedom is choosing the

truth in love (communion) with/for self and another (actus humanus)

A person becomes (actualizes himself) what he was created to be when he chooses the good

The Relationship Between Faith and Reason

Are Faith and Reason Incompatible?

Does Reason Have Limits?

Can tenets of Faith legitimately contradict reason?

Epistemological Theories

Scientism: There are no valid forms of knowledge outside the scientific method; religion, metaphysics, theology etc. are generated by emotions, or biologic processes

Eclectisism: blending of different methods of reason, philosophy, theology without attention to internal coherence

Pragmatism: Religion is useful to humans, but not necessary; makes no claims on its origins

Nihilism/Marxism etc: Religion and spirituality, like human existence, are absurd or harmful

Fides et Ratio: A Unity of Knowledge in Christianity

“[The Christian notion of the Resurrection] is the reef upon which the link between faith and philosophy can break up, but it is also the reef beyond which the two can set forth upon the boundless ocean of truth. Here we see not only the border between reason and faith, but also the space where the two may meet.”

Fides et Ratio, Sect 21, 1998

“In an age when scientific developments attract and seduce with the possibilities they offer, it's more important than ever to

educate our contemporaries' consciences so that science does not become the criteria for goodness…

[Scientific investigation should be accompanied by] research into anthropology, philosophy and theology to give insight into man's own mystery, because no science can say who man is, where he comes from or where he is going… Man is not the fruit of chance

or a bundle of convergences, determinisms or physical and chemical reactions…”

Pope Benedict XVI, address to the Paris Academy of Sciences and the Pontifical Academy of Sciences, January 28, 2008

Science has a Purpose “Thus science and technology require, for their

own intrinsic meaning, an unconditional respect for the fundamental criteria of the moral law: that is to say, they must be at the service of the human person, of his inalienable rights and his true and integral good according to the design and will of God.” (DV , n. 2)

ART: The Science

The Infertility Crisis Infertility is a real and growing problem in

contemporary society. 7.4% of married women of childbearing age are infertile; 2% had

sought some kind of medical treatment (CDC, 2007) 1/3 female-cause; 1/3 male cause; 1/3 both or unknown

Reasons: Delayed age of marriage Oligospermia or azoospermia in men Ovulation disorders Physical defects (blocked fallopian tubes, endometriosis) Increased sexual activity (increased STDs and PID) Undiagnosed STDs Genetic factors

The Infertility Crisis More than 3 million IVF

babies have been born worldwide (56% in Europe)

Only 5% of US Catholics use some form of Natural Family Planning Source: National Survey

of Family Growth

Fertilization TechniquesFertilization Techniques:

Extra-Corporeal (outside the body) IVF-ET ICSI ZIFT

Intra-Corporeal (inside the body) GIFT IUI/AI

Extracorporeal: IVFIn Vitro Fertilization (IVF)

1% of all live births in the US (doubled over decade)

29% of IVF cycles led to a live birth; 18% of IVF pregnancies did not

Number of embryos transferred varies from country to country (e.g., UK/NZ/Australia: 2; Greece: 3)

ASRM: age-dependent (2-5), but no limit to # conceived

Source: CDC website: http://www.cdc.gov/art/ART (accessed 5/2010)

The Use of ART is Increasing

http://www.cdc.gov/art/ART


Transfer of Embryos


Extracorporeal: ICSI

Intracytoplasmic Sperm Injection Used in 40% of IVF


Use of ICSI


Intracorporeal: IUI/AI

Intrauterine Insemination/Artificial Insemination Used for male factor, nondonor sperm, or unexplained

infertility

GIFT (Intracorporeal) & ZIFT (Extracorporeal)

Gamete Intrafallopian Transfer 25-35% success rate

Zygote Intrafallopian Transfer 65% success rate

Ooplasmic Transfer and SCNT

Ooplasmic Transfer: combines sperm, egg, and cytoplasm from a third party donor egg to create an embryo

Human Reproductive Cloning Broad consensus against

this (for now) in US, BUT…

Somatic Cell Nuclear Transfer (“Therapeutic Cloning”) & its link to

ESR

Other Important Terms

Surrogate Motherhood (Gestational surrogate vs Surrogate Mother)

Pre-implantation Diagnosis

Heterologous vs Homologous Embryo Transfer Homologous: The sperm and egg originate from

spouses. Heterologous: The sperm or egg is from a donor who is

not a spouse

"You will know the truth, and the truth will make you free." (Jn 8:32)

ART: The Philosophical Arguments

1. The Embryo Question

2. The Right to Parenthood

NO: But, that doesn’t mean that facilitating one’s desires isn’t a good thing

NO: People should accept what they have; not all desires should be fulfilled if they may lead to ethical problems

YES: A negative right—they have a right not to be interfered with

YES: A positive right—someone has a duty to facilitate a person’s desire to have children

3. The Social Impact of ART Multiple gestations have quadrupled over the last 25 years

preterm labor and birth PIH (3 x the risk) Anemia (2 x the risk) birth defects (2 x the risk) miscarriage twin-to-twin transfusion syndrome abnormal amounts of amniotic fluid cesarean delivery postpartum hemorrhage

3. The Social Impact of ART Gamete donation and

Surrogacy: Exploitation? Marketing?

3. The Social Impact of ART Access

What restrictions to access are justified?

3. The Social Impact of ART

The Frozen Embryo Question Embryo Adoption

200, 000+ in the US Embryonic Stem Cell

Research—does ART lead to a “positive good?” Or, does ESR “resolve” an ethical dilemma?

4. Eugenics and Pre-Implantation Diagnosis

Fewer children being born with cystic fibrosisGlobe and Mail, Friday, October 28, 2005

The number of children born with cystic fibrosis has fallen sharply since Canadian researchers discovered the genetic cause of the debilitating disease in 1989.New research, published in The Journal of Pediatrics, shows that one in 3,608 babies is born with CF, down from one in 2,714 before a genetic test existed. "Our hypothesis is that pregnancies are being terminated," Dr. Mary Corey, a senior scientist at the Hospital for Sick Children in Toronto, said in an interview.

5. The Technological Imperative

‘Without tools [man] is nothing; with them he is all.’

---Thomas Carlyle (1841)

Summary

The Catholic Church insists on both the primacy and dignity of the human person

There is no contradiction between faith and reason

Given the rapid pace of technological advancement, there are at least some prima faciae reasons for critiquing ART.

Donum Vitae (1987)Technology at the Service of the

Person

Those techniques are acceptable in which one simply has the transfer of the egg into a more favorable place in which to encounter the sperm which is deposited after a normal sexual union, without other medical interventions.

E.g., LTOT

Donum Vitae:Pastoral Note

Every child which comes into the world must in any case be accepted as a living gift of the Divine Goodness and must be brought up with love.

21st Century Questions

1. Why does the Church care about MY choices and MY freedom?

2. Doesn’t the Church encourage children? Isn’t ART is very “pro-life,” and “pro-family?”

3. Why is the Catholic Church always AGAINST everything?

Dignitas Personae (2008): Fundamental Principles

1. “The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life” (n. 4).

All Human Life is Sacred

Every human embryo should be treated as a person with an immutable nature.

DP asserts that every human embryo is a person with dignity.

An embryo should not be treated as an object for experimentation, research, or even to “fulfill” the wishes of prospective parents.

1. Why does the Church care

so much about MY choices

and MY freedom?Because authentic freedom involves not just choosing—but choosing the good.

IVF establishes the “domination of technology over the origin and destiny of the human person” (n.

17).


2. “The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman.

Procreation which is truly responsible vis-à-vis the child to be born must be the fruit of marriage” (n. 6).

The Outcome Does Not Justify the Action

Evil is not to be done that good may come of it. (Romans 3: 8)

Tomb of St. Paul, Rome

An act should be good through and through

“’As for acts which are themselves sins (cum iam opera ipsa peccata sunt) …who would dare affirm that, by doing them for good motives (causis bonis), they would no longer be sins, or, what is even more absurd, that they would be sins that are justified?“ Pope John Paul II, quoting

Augustine, Veritatis Splendor, para. 81

St. Augustine of Hippo

2. Doesn’t the Church

encourage children? Isn’t ART

very “pro-life,” and “pro-

family?”

Objectionable ART techniques justify the means via the ends Techniques such as IVF inevitably lead to embryo destruction and the violation of dignityIVF dissociates procreation from its personal context and replaces it with a technical procedure (n.16).


3. DP outlines five categories of procedures :

1. Techniques of heterologous artificial fertilization (n. 12)

2. Techniques of homologous artificial fertilization (n. 12)

3. Techniques which act as an aid to the conjugal act and its fertility (n. 12).

4. Techniques aimed at removing obstacles to natural fertilization (n. 13).

5. Adoption (n. 13).

Dignitas Personae (2008): Not “Anti-Everything!”

Techniques are morally permissible if they respect:

“the right to life and to physical integrity of every human being”,

“the unity of marriage” “the specifically human values of sexuality” (n. 12)

Procreation results from the conjugal act specific to the love between a husband and wife.

“Techniques which act as an aid to the conjugal act and its fertility are permitted” (n. 12).


“Certainly, techniques aimed at removing obstacles to natural fertilization… are licit” (n. 13).

Hormonal treatments for infertility Surgery for endometriosis Unblocking/surgical repair of the fallopian tubes NaPro Technology/Creighton CCL


“Adoption should be encouraged promoted and facilitated…”(n. 13).

Primacy of the child’s welfare (n. 19).

DP’s position on embryo adoption: Is not definitive As a treatment for infertility?: NO Prenatal adoption?: ambiguous

3. Why is the

Catholic Church

always AGAINST

everything?The Church supports the aiding of the conjugal actThe Church supports the removal of barriers to conceptionThe Church supports adoption

(Not (Not everything, everything, just bad just bad things)things)

Catholic and Protestant Differences

Catholic (Donum Vitae)

Approves of: Depends on the measure

in which they respect the constitutive dimensions of human procreation and the integrity and dignity of the embryo.

Proscribed: procedures which obscure

the sense of the dignity of procreation and its relationship with the incarnate, conjugal love of the spouses.

Protestant (CMDA)

Approves of: AI by husband Homologous IVF with

transfer to uterus ZIFT GIFT Cryopreservation with

intent to implant

Ambivalent Heterologous IVF

What Must We Do As Christians?

Have faith [The Apostles after Pentecost] "did not come down

from the mountain carrying, like Moses, tablets of stone in their hands; but they came down carrying the Holy Spirit in their hearts... having become by his grace a living law, a living book". (Saint John Chrysostom)

Have hope, which never fades "With God all things are possible" (Mt 19:26)

Have charity and love for all “Love takes up where knowledge leaves off.” (St.

Thomas Aquinas)

assisted reproductive technology: progress or peril?

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