By Ellen Painter Dollar
In this final post encouraging Episcopalians to learn about and discuss reproductive ethics, I will briefly review some major ethical questions related to Christians’ use of reproductive and genetic technology, and end with a couple of recommendations.
Major Ethical Questions
As is clear from the review of various faith traditions’ handling of reproductive ethics, the ethical questions that reproductive and genetic technologies raise are closely linked with how each tradition views sexuality, marriage and procreation. Christian perspectives on suffering and disability come into play as well, raising questions, for example, about whether preimplantation genetic diagnosis (PGD) is good preventive medicine that uses our God-given scientific knowledge to alleviate suffering, or a eugenic process that emphasizes secular values of perfection and achievement over God’s abundant grace. Sometimes, as I write about these questions, I feel like I’m in some tortuous maze—I go down one path only to find four more paths I could travel down in search of answers. None of it is easy. None of it is simple.
But I’m going to try to simplify it anyway, breaking down the ethical questions into several broad categories.
The Nature of Disability and Suffering: What do Christians believe about genetic disorders that cause pain and suffering? Are they part of God’s plan, the result of a fallen world, or the natural result of a God-given genetic code that relies on change and diversity for its success? What is the nature of the suffering people experience as a result of disability? Are social stigma and exclusion as much factors in how we perceive disability as physical pain?
Desire, Vocation and the Choice to Have Children: Why do many people have such a strong desire for biological children? Is adoption the best answer for those dealing with infertility or genetic disease? Can parenthood be a vocation? Do parents have a duty to protect their future children from suffering?
The Blessing and Burden of Having More Choices: How do assisted reproduction and genetic screening affect our perception of humans? Of God? Is there a “voluntary eugenics” or quality control at work in reproductive and genetic technology? How does increased use of these technologies change our culture’s perspective on disabled people? Can parents be held responsible for disabled children (e.g., barred from public support for their children) if they choose not to use available technology to prevent disability? How do assisted reproduction and genetic screening contribute to or benefit from our culture’s commodification of children?
Money, Medicine and Consumer Culture: How does the money-making side of assisted reproduction affect the relationship between doctor and patient? What values are promoted in the standard procedures followed by most fertility clinics? Is there a “slippery slope” of assisted reproduction (i.e., nearly impossible to stop once you’ve started)? Can genetic screening at the embryonic stage be classified as primary preventive medicine (i.e., a better alternative than therapeutic abortion as the result of prenatal diagnosis)? Is there any evidence that technological reproduction has adverse health effects for parents or babies?
The Status and Selection of Embryos: Given that natural conception often involves selection of healthy embryos and destruction of unhealthy ones (e.g., many miscarriages are attributed to genetic anomalies), whose job is selection—God’s, nature’s, ours? How do patients, doctors and Christians view embryos? Do embryos have rights? Is there a continuum of traits that are acceptable/not acceptable to select for—e.g., life-threatening disorders, non-life-threatening disorders, gender, traits? Because our knowledge of embryos is limited (we can’t always identify the severity of disease in utero, we can’t know what personality or skills the embryo will have as a fully developed person) can we justify making selection decisions based on one characteristic, such as a particular genetic mutation?
Why Episcopalians Need to Care About Reproductive Ethics
As I hope that long list of questions illustrates, reproductive ethics are not only about debating pro-life and pro-choice arguments (although questions of who gets to choose and why are involved), nor are they focused only on whether we think an embryo has the rights of a human being (although that is an important question). Reproductive ethics raise questions about who we are, who God is, our health care system, the nature of procreation and parenthood, and how our culture perceives children. These are big questions—questions no person or couple should have to grapple with on their own, especially if they are part of a faith community.
The most compelling reason for Episcopalians to care about reproductive ethics is that reproductive and genetic technology is getting more sophisticated and available. We can now not only identify genes for life-threatening disorders that will kill or seriously disable an infant, but also for adult-onset diseases with a genetic component, such as breast cancer. In vitro fertilization, originally designed for young, otherwise fertile couples who had some clear physiological problem (a blocked fallopian tube, for example) is now routinely used to assist women in their 40s to have children with the use of donor eggs. While genetic screening has traditionally been available only to couples who have family history of a specific disorder or are part of an ethnic group predisposed to certain disorders (such as Tay-Sachs in the Jewish community), a company called Counsyl recently developed an inexpensive test that allows any couple to be tested for approximately 100 single-gene disorders. It is now possible for a couple to pay for eggs from an anonymous woman, sperm from an anonymous man, a womb from a surrogate mother, and go home nine months later with a child who is genetically unrelated but legally theirs.
More and more people sitting in the pews of Episcopal churches, and more and more people you know—your friends, your siblings, your children, yourself—will face the question of whether to use reproductive and genetic technology to fulfill their dream of heaving a healthy baby. If and when they come to the church, to their fellow believers, for guidance and support, we need to have something to offer them.
What To Do
Avoid easy answers. Infertility is not easy. Living with genetic disease is not easy. Figuring out the right thing to do in light of the long list of major, soul-searching questions raised by new technology is not easy. Easy answers don’t help. When it comes to easy but unhelpful responses, my two pet peeves are: “Why don’t you just adopt?” and “Everything happens for a reason.” I’ve written elsewhere about why I find these responses so unhelpful, misguided and even hurtful, and won’t go into it here. Just don’t say them, or any other easy answer that pops into your head. Please.
Learn and talk about reproductive ethics. There are lots of ways to do this at the congregational level. Sermons, adult forums and book groups are all places where questions raised by reproductive technology can be discussed. Invite an ethicist from a local college or seminary to give a talk or lead a discussion. My book (warning: shameless self-promotion ahead) is designed to be accessible to a diverse audience, and is written in a narrative, non-scholarly style. But it won’t be out until fall 2011, and there is lots of other reading material available: theological discussions, official church documents, memoirs, and short journal and magazine articles. I have developed a reading list of resources I have found inspiring or helpful; if you would like a copy, you can contact me through my Choices That Matter blog.
Thank you for sticking with me through all three parts of this series. There’s a lot to talk about, so let’s get started.
Ellen Painter Dollar is a writer whose work focuses on faith, parenthood and disability. She is writing a book on the ethics and theology of reproductive technology, genetic screening and disability, and she blogs at Choices That Matter and Five Dollars and Some Common Sense.