Tag Archives: Bioethics

The womb and reproductive technologies

Medical advances have led to the possibility of a uterus transplant, but is it ethical ?

Jennifer Kimball

Jennifer Kimball

Classical and theological discourse has always held a unique and deeply significant respect for the womb. Indeed, it’s the place where the human person first experiences communion with another, where the child is nourished and grows under the care of maternal union, where the developing person is most vulnerable and depends upon another in all things.

There’s a cultural norm in Catholic morality which implies a regard for the womb, but this norm has yet to be fully articulated in Church teaching. Its absence can be understood when looking at the Church’s early understanding of human embryology. In the 13th century, Thomas Aquinas thought that human life began only from the man’s sperm, his “seed.” The woman’s participation in conception was thought to be passive. It’s interesting to note, however, that the woman’s “seed” is mentioned much earlier (Gen 3:15).

The womb, or uterus, is part of the female reproductive system, yet outside of the generative capacity of the system itself. The womb doesn’t participate in conception, but it’s where a new life grows and develops.

By design, the womb doesn’t serve the physical integrity of the woman, such as the kidney or liver, but exists to serve another — actually drawing, to a small degree, from the physical good of the woman, demanding her gift of self.

Given that the womb exists for another and bears a deeper relational significance not yet fully articulated by the Church, Catholic bioethicists may need to address future issues such as womb donation and the gestation of embryos in artificial/mechanical wombs. In delving into these questions, we contribute significantly to current debates such as early embryonic transplants to save the life of the fetus. Are artificial wombs intrinsically wrong? Suppose a pregnant woman needs radiation therapy to prevent her death from cancer (and the unborn baby’s death as well). Would it be immoral to move the unborn child from the mother’s womb to an artificial uterus to protect its life?

In 2006, the review board for New York’s Downtown Hospital granted approval for Dr. Giuseppe Del Priore to perform the United States’ first human uterus transplant. The first known attempt was performed in Saudi Arabia in 2000. It was removed after 99 days due to clotting of the blood, even after two successful menstrual cycles. Upon hearing of the N.Y. board’s approval, barren women were lining up to receive a new uterus. With many cases of endometriosis and scarring of the uterus, conception can still occur in the fallopian tubes and travel the four to six days to the uterus. The problem with these illnesses, however, is not necessarily the lack of conception, but that the womb becomes inhospitable to the embryo, causing a failed attachment and the resultant death of the embryo. Given that medicine has sought a nonconventional therapy in the form of transplants, we must ask if it’s ethical.

The Church teaches that “ethically, not all organs can be donated. The brain and the gonads may not be transplanted because they ensure the personal and procreative identity respectively. These are organs which embody the characteristic uniqueness of the person, which medicine is bound to protect” (Pontifical Council for Pastoral Assistance, Charter for Health Care Workers, 1995, #88).

The uterus, though part of the reproductive system, does not comprise generational or personal identity of the donor such as with the ovaries, testes or brain. This may suggest that to donate this organ for the sake of another’s conceived children may be licit in Church teaching, though the need for such a transplant may only be realized as a result of advances in reproductive medicine and technology.

With a uteral transplant, a woman’s uterus is removed and then placed in another woman’s body in the hope that the woman and her husband may conceive a child. In formulating an ethical regard for transferring a heterologous (foreign) uterus into the body of another woman, will we need to consider marital or sexual ethics?

A child gestating in the donated womb within its biological mother is not foreign to the father nor is it generated without his participation. It also seems reasonable to say that the transplantation of the uterus, though part of the reproductive system, is not a sexual act in any fashion. It’s a medical procedure that provides an actual good for both the fulfillment of the marriage and the gestation of their children.

A woman’s becoming pregnant after such a transfer remains to be established as a result of the natural marital union. The gestation of the couple’s child, however, comes about through the gift of another though it remains personal to the mother and to her body.

I believe that, as technology progresses, the Church may rule that it’s permissible to transplant a womb in order to save another — and to gestate and nurture a human life.

Jennifer Kimball is executive director of the Culture of Life Foundation, a non-profit policy think tank based in Washington, D.C. She earned a bachelor’s degree and a Licentiate in Bioethics from the Pontifical Athenaeum Regina Apostolorum School of Bioethics in Rome.

Death in a test tube

Dignitas Personae takes on bioethical concerns including freezing human egg cells. . . 

Fr. Alfred Cioffi

Fr. Alfred Cioffi

The Vatican examines the treatment of human embryos in its bioethics document Dignitas Personae, released late last year. The document takes on a myriad of bioethical concerns including freezing oocytes (immature ova or egg cells), the reduction of embryos and preimplantation diagnosis. Though none of these procedures is new, they have drawn the Vatican’s attention and that of Catholics around the world.

Freezing oocytes

Sperm banks have been freezing and thawing sperm (cryopreservation) for over 40 years. Freezing and thawing eggs (oocytes or ova), however, has been more difficult, mostly due to their much higher water content which tends to expand and contract during the process, thus destroying the cell. But earlier this decade, scientists began reporting success in cryo-preserving human eggs to the point that there are now also egg banks.

Theoretically, freezing human eggs is not intrinsically evil since there are some clinical settings in which a woman might benefit from such a technique (for example, to evaluate some aspect of her fertility that is otherwise impossible to ascertain). That is why, in making its moral evaluation, Dignitas Personae (DP) focuses on the intention for freezing a human egg. If the purpose is for in vitro fertilization (IVF), then the procedure is morally tainted. “In this regard it needs to be stated that cryopreservation of oocytes for the purpose of being used in artificial procreation is to be considered morally unacceptable” (DP #20). Emphasis in the original.

In June, New York’s stem cell board agreed to use public funds to pay women who donate their eggs for research. However, there are serious risks involved: Ovarian hyperstimulation and egg retrieval are dangerous and can be fatal. They can only be justified for extremely grave reasons. Women are often exploited for their eggs through financial incentives, which is the case in New York.

Embryo reduction

In a normal IVF procedure, typically three to four embryos (blastocysts) are inserted into the woman’s uterus; on average, only one implants. The other two or three are discarded by her body. There are times, however, when two, three, four or even more of the embryos implant. Because the woman or couple only wanted one child, they are offered the choice to terminate the “excess” embryos. In order to make an informed choice, the embryos or fetuses in her womb are tested for genetic defects and for gender. They can then select to abort the ones that might be carrying some genetic defect or are the “wrong” gender.

To intentionally kill a human being, no matter how early in development, is a grave moral evil. When this is done on the basis of the intentional selection of inheritable traits, it’s called “eugenics” and has serious consequences for all of society. “From the ethical point of view, embryo reduction is an intentional selective abortion. It is in fact the deliberate and direct elimination of one or more innocent human beings in the initial phase of their existence and as such it always constitutes a grave moral disorder” (DP #21). Emphasis in the original.

Preimplantation diagnosis

Preimplantation diagnosis (PID) is a type of prenatal diagnosis involving the three-to-four-day-old embryo before implantation (thus, PID is associated with IVF). Typically at the eight-cell stage, while the embryo is still growing in a Petri dish in a lab incubator, a single cell is plucked out and sent for genetic testing (karyotyping) and gender determination. The results can be used to choose for or against implanting that particular embryo.

This is another form of eugenics. In addition, there are further grave considerations for condemning PID: First, since each cell has the capacity to develop into a whole new embryo, extracting one cell (which could in fact be creating a new human being who will then be destroyed during the genetic analysis), another abortion will have occurred.

Second, there is no solid evidence yet that extracting a cell at this stage does not cause significant damage to the early embryo. To find out with certainty would require even more human embryo experimentation, which would be a gross violation of human rights.

Third, PID genetic testing is not accurate science, leading to the real possibility that many “normal” embryos will be killed due to false positive results (that is, that they indicate anomalies where there are none). Also, lethal selection based on gender is a grave intrinsic evil which should be self-evidently abominable.

“Preimplantation diagnosis, connected as it is with artificial fertilization — which is itself always intrinsically illicit, is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion” (DP #22). Emphasis in the original.

All three procedures — egg freezing, embryo reduction and preimplantation diagnosis — are closely associated with IVF, which has drastically negative consequences for human embryos, the parents who choose this method, the medical profession and society at large. Hence, it is imperative for people of influence (and all people of good will) to speak up against the IVF industry and its associated technologies, which is leading the contemporary developed world into eugenics. What makes the nefariousness of this eugenics even more urgently condemnable is the fact that IVF gives the appearance of being pro-life, but is not.

Rev. Alfred Cioffi, STD, Ph.D., is a staff ethicist for the National Catholic Bioethics Center.

The Vatican and human dignity

Three principles govern Dignitatas Personae‘s moral analysis of human embryos and their conception

Dr. Edward Furton

Dr. Edward Furton

The Vatican examines new reproductive techniques and the treatment of human embryos in its latest bioethics document Dignitas Personae. Generally, the Church teaches that the techniques of medicine may only assist the procreative act and may not replace it. Here the rule of thumb is that conception should take place within the body, not outside. A corresponding rule governs the treatment of human embryos who ought to be conceived through the marital act, not engendered in vitro by a laboratory technician.

More broadly, Dignitas Personae (DP) lays out three principles that govern its moral analysis in this area: “The right to life and to physical integrity of every human being from conception to natural death; the unity of marriage, which means reciprocal respect for the right within marriage to become a father or mother only together with the other spouse; and the specifically human values of sexuality, which require that the procreation of a human person be brought about as the fruit of the conjugal act” (#12).

Any medical technique which conforms to the third principle enunciated above is morally acceptable, for conception will necessarily take place through the immediate sexual act of the married couple. Thus the removal of obstacles to the natural process of fertilization, such as surgery for endometriosis or the unblocking of the fallopian tubes, is morally licit because it assists the marital act. In vitro fertilization, in contrast, takes place without the marital act; hence, it is clearly an act of replacement.

Not only does in vitro fertilization replace the marital act, it also allows for the violation of the first and second principles set forth above. All in vitro fertilization separates conception from the immediate act of sexual union between the spouses, but it can be further deformed when the gametes (the sperm and the ovum) are not taken from the married couple themselves. A married man can use the ovum of any woman, or a married woman can use the sperm of any man, to engender a child in a Petri dish. Indeed, there is no requirement that one even be married. Sperm and ova are offered for sale and can be purchased by anyone. An unmarried man or woman could buy these materials on the market, pay a technician to have them combined in vitro, and then implant the embryo into a surrogate “mother.” This would engender a child without any genetic connection whatsoever to the producer. Obviously, this treats human life as a commodity.

In vitro fertilization also kills many embryonic human beings through neglect or intentional destruction. DP notes that fertility clinics consider the number of embryos destroyed to be inconsequential compared to its rate of success in achieving births. The clinic is mainly interested in “obtaining better results in terms of the percentage of babies born who begin the process, but does not manifest a concrete interest in the right to life of each individual embryo” (#14).

DP also points out the profoundly troubling fact that couples are now “using artificial means of procreation in order to engage in genetic selection of their offspring” (#15). This is eugenics, the use of techniques of animal husbandry to produce the fittest offspring. Eugenics has often been forced on an unwilling population by the power of the state (i.e., China’s infamous “one-child” policy). But in the U.S., we have a consumer-driven model where individual parents select the traits (including gender) they want to see in their children. A single cell can be removed from an early stage embryo produced in vitro, and if that cell shows undesirable traits, the embryo is destroyed. The parents search through their embryos until the suitable genetic traits are found. This embryo is then implanted and brought to term.

These practices reveal two deeply troubling attitudes animating the use of modern reproductive technologies: a base utilitarian approach toward the production of human life and a disregard for the inviolable dignity of every human being. The first is exemplified by techniques better suited to the production of livestock. The second shows itself in the willingness to countenance a staggering loss of human life, a rate that would not be permitted in any other field of medicine, and which demonstrates that all claims about “respecting” embryonic life are without merit.

Leaving human procreation in the hands of laboratory technicians represents a serious danger to our future. If technicians are to be given the authority to control and manipulate the origin of the human being, they will not only have power over the life or death of the embryo, but also the power to decide what life will be allowed to come into this world. They will decide which traits are most desirable, which racial characteristics are preferable, which sex should predominate in numbers. They will stand before us as gatekeepers, advising parents on what is possible, what is moral and what is ideal. We will no longer rely on the workings of nature to decide our offspring in its own mysterious way. Some have already assumed these gargantuan tasks to themselves, claiming an authority superior to nature, and pretending to walk among us as if they were gods.

Dr. Edward J. Furton is the director of publications for the National Catholic Bioethics Center.

Once more into the breach: the Church’s new bioethical document

We live in a biotech age, and the Holy See knows it. Almost daily we read of attempts to engender new creatures using, for example, cows’ eggs that have had their DNA genetic material replaced with human genetic material.

We learn that vaccines are produced using cell lines developed from tissue taken from aborted babies. We find ads in women’s magazines for cosmetics made from human stem cells. We discover that there are more than 500,000 frozen human embryos in liquid nitrogen. Sometimes it is as though we have walked through an open door into Dr. Frankenstein’s laboratory, but this is the world we live in today!

In December, the Catholic Church once again raised her voice against these abuses of human dignity in a new formal teaching document known as Dignitas Personae. Indeed, the Church is the sole surviving institutional voice defending humanity against such indignities. On Dec. 12, the Feast of Our Lady of Guadalupe, the Holy See released a document on bioethics which had been officially approved by Pope Benedict XVI on Sept. 8, 2008, the Feast of the Birth of the Blessed Virgin Mary.

The Holy See usually pays close attention to the significance of dates when it promulgates and releases documents. This bioethics document, issued by the Congregation for the Doctrine of the Faith, the highest doctrinal office in the Church, was formally approved and then released on two great Marian feasts, as if to say that Mary stands as the example of love for God’s precious gift of life. After all, she was the one who bore within her womb the helpless, the vulnerable, the unseen human life of God himself! Her example bears witness for all time to the veneration we should all have toward God’s precious gift of life.

In 1987 — more than 20 years ago — the Holy See issued its first major document on contemporary bioethics known as Donum Vitae. This was issued also by the Congregation for the Doctrine of the Faith, which was headed by then-Cardinal Josef Ratzinger on Feb. 22, the Feast of the Chair of St. Peter, representing the teaching authority of the See of Rome. It embraced scientific advances in overcoming infertility and rendered ethical assessments on the most commonly used methods for achieving pregnancy.

The Catholic Church is often accused of being behind the times and not scientifically current. Donum Vitae itself, however, puts the lie to that perception. The document was thoroughly conversant with the science of the day. In fact, it judged human cloning to be beneath the dignity of the human person and an illicit way to overcome infertility.

This was in 1987 — 10 years before Dolly the Sheep was cloned. When the Holy See reached that judgment, many mammalian biologists thought it would be impossible to clone a mammal. So we see that rather than being behind the times, the Church was ahead of the curve!

With Donum Vitae, the Church formally taught that in vitro fertilization — or the engendering of human life in a Petri dish — was a violation of human dignity. It violated the dignity of the child at its coming into being by making it susceptible to the life and death decisions of others, and in vitro fertilization was judged to be a violation of the nobility of the means God established for bringing new life into the world — the profoundly personal act of marital intercourse. It warned then of abuses that would occur. Now, 22 years later, the Church speaks again in defense of human dignity in the face of more than 500,000 human embryos frozen in liquid nitrogen, left over from in vitro procedures.

Even as the Church pays close attention to the feast day on which its documents are issued, even so it pays close attention to the opening words, which invariably become the title of its documents. In 1968, Paul Paul VI issued his encyclical on contraception and began it with the words humanae vitae — of human life. In 1987, the document on bioethics was entitled Donum Vitae (The Gift of Life). This most recent document is entitled Dignitas Personae (The Dignity of the Person).

We can see that the Church’s fundamental concern in assessing these human actions — and passing judgment on them — is preserving the dignity, goodness and inviolability of the human person. The Church looks with horror on human life being engendered for experimentation and destruction in our day. It is appalled to see scientists playing God.

John M. Haas is president of the National Catholic Bioethics Center and founding president of the International Institute for Culture. He is a member of the Pontifical Academy for Life.