About 10% of women of child-bearing years, that is 6.1 million women in the U.S., suffer from infertility (the inability to get pregnant after 1 year of trying or after six months of trying for those 35 or older). For many, an infertility diagnosis leads them to seek out assistance through artificial reproductive technologies (ARTs) like in-vitro fertilization (IVF) or gestational surrogacy, the use of which helps many infertile couples have the children they always dreamed of. The Roman Catholic Church, however, is well-known for its opposition to the use of such technologies, a stance which has become increasingly unpopular as ARTs become more common (You can read about the Church’s position on IVF here and here). Sean Savage, a Roman Catholic himself, presents an impassioned plea over at CNN’s Belief blog, for the RCC to change its stance on ARTs to accommodate for Catholics like him and his wife who resort to IVF to have the children they always dreamed of.
Babies born of IVF are here because their parents loved, respected and longed for these children well before conception. These children could not get here through the conjugal love of their parents and it took a very deep love, respect, and commitment to pursue the medical treatment needed to conceive through IVF. There is no doubt in my mind that God is working through loving parents and ethical doctors to allow these children to come into this world.
The Church’s opposition to IVF is based on a number of factors. On one hand, there is the concern that unused embryos will be destroyed, which the Roman Catholic Church categorizes as murder since life begins at conception. On the other hand, there is the emphasis on the dignity of the marriage act where “human procreation is a personal act of a husband and wife, which is not capable of substitution.” Savage addresses both of these arguments in his post, concluding that neither is a convincing counterpoint to couples like him who try desperately to conceive, and fail.
In any moral response to IVF, it is important to remember how painful and stressful infertility is for couples like the Savages. They watch their couple friends get pregnant, attend baby showers and baptisms, and ooh and ah over all the baby pictures that their friends put up on Facebook, all the while mourning their inability to fully share in the joy of having a child. For many couples, the stress and anger over an infertility diagnosis can negatively impact the marriage as well.
For many couples like the Savages, doctors are unable to identify a clear cause of their fertility problems. This uncertainty can heighten the couples stress as they wonder if they themselves are to blame. They wonder, “Is it something I am doing or have done?” Was it because I exercise too much? Because I drank a glass of wine at dinner? Is it something I am eating or not eating?” Many women do not tell others they are struggling with infertility in fear of receiving blame from others who do not understand why they can’t have a baby if nothing is physiologically wrong with them. Compounding all of this is the claim that stress also causes infertility. But infertility is nothing if not stressful, and stress becomes just another thing to feel guilty about: “Am I not having a baby because I am too stressed out?”
Despite all of this, I want to try and approach the question of the morality of Artificial Reproductive Technologies (ARTs) like IVF from a different angle than the Church’s official documents. I want to ask: What sort of people do these technologies turn us into? Does IVF lead us into a more Christ-like way of life? This approach is what we call a character-based approach to morality, as opposed to an act-based approach which attempts to argue that certain acts like IVF are morally licit or illlicit. A character-based approach to morality focuses on the moral agents themselves, and sees the acts as both expressions of their moral character, and causes of character formation.
Savage would clearly say that IVF allowed him and his wife to become the loving parents they had always dreamed of, and I think he’s right. I can recognize and marvel at how IVF has allowed so many people who could not have children on their own become loving parents. But on the other hand, the use of IVF and other ARTs also potentially reinforces in our own lives and our own characters the consumerist mentality that we can have whatever we want whenever we want it, and that true freedom resides in having as many options as possible.
A recent article on NPR’s Morning Edition does a good job illustrating how ARTs reinforce this consumerist mentality.
As more women postpone motherhood into their 30s, even 40s, they’re hitting that age-old constraint: the biological clock. Now, technology is dangling the possibility that women can stop that clock, at least for a while. . .
. . . Dr. Alan Copperman of Reproductive Medicine Associates of New York wastes no time laying out this harsh reality: By the time a woman hits her 40s, 90 percent of her eggs are abnormal. The chances of a typical 40-year-old getting pregnant in any given month? Ten percent. Unless, that is, she gets pregnant with her younger eggs — eggs she had frozen years before. . .
. . . The whole process — a week of hormones, plus the procedure to collect the eggs — runs $12,000 to $14,000. And because it takes 10 to 20 eggs for a reasonable shot at success, some may need to do this several times. Plus, there are annual storage fees. Then, when you’re ready to use your eggs, you’ll need in vitro fertilization, another pricey procedure. All told, costs can easily exceed $40,000.
Women are postponing motherhood as they pursue things like education and career, both good things. The consumerist mentality reinforces to these women, however, that they should be able to have a family too—on their terms (and with a hefty price tag). Such practices as the ones mentioned in this article also render children into a commodity, something to be purchased, rather than lovingly received. For Christians, a child is seen not as an object which one has a right or an entitlement to, but as a gift. Sean O’Malley, my own bishop, expresses well how ARTs commodify children:
One of the greatest absurdities of contemporary society is that our country has approved of people aborting all unwanted children and at the same time permits an immoral technique (in vitro fertilization) that allows a few women to have the experience of a pregnancy. In both of these circumstances the fate of the children is subordinated to the convenience or the personal aspirations of the parents.
Savage too, despite his good intentions of love and parenthood, also reinforces this consumerist mentality. Additionally, his article points to another problem with ARTs: they potentially render us inhospitable people:
Carolyn and I would have been happy to save thousands of dollars and a decade of emotional ups and downs by conceiving the “old-fashioned way,” but that wasn’t possible. We turn to medicine for a litany of medical maladies and impairments, but infertile Catholics are supposed to avoid treating a medical condition which prevents them from building or expanding their family?
Yes, adoption is a wonderful option for the couples who decide it’s right for them, but adoption should never be forced on anyone.
Later on, Savage argues against what he sees as the Church’s discrimination against his child conceived through IVF, writing that “one child is as perfect as another.” Yet his refusal to adopt in light of his strong desire to “have a big family” would suggest that in his eyes, children of strangers are actually not as perfect as those who share his DNA.
Hospitality is the virtue that allows us to welcome the stranger. Hospitality is the virtue which tears down the boundaries between “us” versus “them.” It is hospitality most of all that I see missing from Savage’s argument for IVF. He wants children, and lots of them, but only if they are “his own.” And while it is clear that he loves his children, there seems to be a big difference for him between what constitutes “his” child and the child of a stranger. Of course, from a Thomistic perspective, I would say that the order of love demands that we love our family and care for them more than strangers. But the order of love does not give us the license to make demands about who is going to be included in our family. When God offers the gift of a child, we welcome them as our family whether the child is the product of a pregnancy or an adoption.
Adoption in Savage’s case would be an exercise in hospitality. Adoption, unlike ARTs is also a social practice which reinforces the mentality that children are gifts to be lovingly received, and not commodities subject to our convenience. Pope John Paul II wrote in Familiaris Consortio: “Christian families, recognizing with faith all human beings as children of the same Heavenly Father, will respond generously to the children of others, giving these children support and love, not as outsiders, but as members of the one family of God’s children. Christian parents will thus be able to spread their love beyond the bonds of flesh and blood, nourishing the links that are rooted in the Spirit.”
Open adoption especially is an exercise in hospitality. In open adoption, the child is raised knowing they are adopted:
She can feel confident and comfortable (instead of disloyal) by being curious or inquisitive about her birthparents. She is encouraged to care about her adoptive family and her birth family. She has a sense of belonging because she knows her birthparents selected her parents” (Catholic Social Services of Montana)
In open adoption, the adopting family opens their home and their hearts not only to the adopted child, but also to the birthparents who are given the opportunity for ongoing contact with their child. In open adoption, the gift of life is something that can be valued by both the adoptive and the birthparents as both marvel in gratitude and humility at the life that unfolds before them.
It is true that adoption isn’t for everyone. I am in no way trying to articulate a duty to adopt. I am arguing, though, that for people like the Savages, the desire for a big family and the corresponding refusal to adopt does seem morally problematic. This is especially true for Christians who are the adopted children and heirs of God (Galatians 3, Romans 8).
Now, I do think that the Church has done an insufficient job laying out a theology of adoption. The adoption of children as a solution to infertility receives only passing glance in the Catechism of the Catholic Church:
2379 The Gospel shows that physical sterility is not an absolute evil. Spouses who still suffer from infertility after exhausting legitimate medical procedures should unite themselves with the Lord’s Cross, the source of all spiritual fecundity. They can give expression to their generosity by adopting abandoned children or performing demanding services for others.
While organizations like Catholic Social Services do wonderful work making adoption possible, the Church’s “no” to IVF and other ARTs might be easier to swallow if it were accompanied by a more confident “yes” to adoption.
In conclusion, when looking at an ethical issue like IVF, I think it is important to do so from the perspective of character, asking “What sort of people is this practice (of IVF) turning us as a society into?” Savage’s desire to have a child is not what I find problematic. It is the perspective that sees a child as a right and the desire to have only the child you choose that I have a problem with. A child is a gift, and when it comes to gifts, we readily accept what we are given rather than demand precisely what we want. In my mind, the Church’s teachings on IVF and other ARTs are there not to keep people from having families (and big families at that), but rather, to inculcate in them the habits necessary to view and receive the gift of life–habits like hospitality, gratitude, and humility.
Gratitude is a part of justice, of giving to others what is due to them. For Aquinas, in receiving a gift, more attention is given to the magnanimity of the giver than the gift itself. As such, the repayment of gratitude should be in excess of the gift received because gratitude responds not only to the gift, but to the benefactor. The benefactor, he writes, deserves praise for “having conferred the gift without being bound to do so” (II-II, 106.6). When it comes to life, God is the benefactor, and God is under no obligation to bequeath on us the gift of life. The virtue of gratitude allows us to see that children are not something God owes us and subsequently, that having a child is not a right. Closely related to gratitude, then, is the virtue of humility.
Humility is the virtue which restrains the appetite from pursuing things not in accord with right reason, or things that are not in accord with one’s station. Aquinas says that it belongs to humility “that a man restrain himself from being borne towards that which is above him” (II-II 161.2). But nothing is further above humans than to give and take life because God is the Lord of Life (Deut. 32:29). This is not to deny that we can use medicine to help women have children. But IVF, unlike other treatments like hormone therapy, allow us to choose which lives will come into existence and under which circumstances (the thousands of “spare” embryos frozen around the country are a testimony to this—spare lives to be used if the first round of IVF doesn’t take). IVF and other ARTs usurp this sovereignty God has over life. The moral theologian who has best articulated this argument against IVF, Stanley Hauerwas, is actually not Catholic, but his argument holds for Catholics. In his testimony on IVF before the Ethics Advisory Board of the Dept. of Health, Education, and Welfare, Hauerwas stated:
“Christians must surely be doubtful of any moral defenses of in vitro fertilization that claim this technique as an extension of freedom from natural necessity. From our perspective, such a claim involves the pretentious assumption that there is no limit to the right of people to perpetuate themselves.”
We are the beneficiaries of life, not the producers of life. By refusing IVF and other ARTs which promise to give us the child we want, we develop the virtues of gratitude and humility which are necessary to be good stewards of life. By pursuing adoption, we become more hospitable people, people who take seriously the prophetic injunction to care for the orphan.
Excellent piece, Beth – I did an article (Josephinum J of Theo, 2007) where I argued that, in order to make sense of the “hard teachings” of Catholic sexual ethics, one needs not simply a virtue frame, but specifically the frame of Aquinas’ treatment of charity. I focused on contraception and “committed” premarital sex, but I think this kind of a description of a classic IVF case also fits. A big part of the difficulty here has to do with the clash between the norm (saying something is completely wrong) and the actual experience (loving the child, etc.) – in fact, this couple may not be suspectible to the selfishness critique, in the same way that it seems problematic to accuse all couples who use contraception of “selfishness.” But the giveaway in your story is the response on adoption – it is seen as a kind of act of supererogation. The problem here, it seems to me, is the inability to see one’s marriage as a school of and sign of charity – a problem that probably infects both fertile and infertile couples and their attitudes toward their children and families!
Great piece Beth! Infertility is a large cross, and people should not neglect the pain it brings to many couples. Your post reminds us of this (with Savage), and also asks us to remain open to seeing how new life can come from the experience of this cross. The lens of hospitality here is spot on.
The consumerism and commodification you identify is a great problem with how many of us young couples have children today. And it is by no means limited to IVF. I think of friends whose relentless pursuit of children leads to a scheduled, programmatic sex life that can only be called ruthlessly regimented. I think of peers who have entered into an adoption process shot through with consumerist problematics. And these are of course ways of having children that are not intrinsically problematic according to Catholic teaching. This is not even to mention any artificial methods that are permissible by the Church as they do not separate unitive and procreative (use of ovulation enhancing drugs, e.g.). The concern for consumerism, commodification, and (as I like to say) manipulation and management is even broader than IVF.
This of course raises questions relevant to classic moral theological debates about “where” the locus of sin is here. It is clearly largely in the intentionality of the processes, since even having kids the “old fashioned way” can be done in a commodified and instrumentalizing manner. That problematic intentionality needs to be named, clarified, and exposed for what it is so we can be led away from it.
That still leaves the question of whether any “techniques” are in themselves (intrinsically) immoral. The recognition that even acts that can be virtuous can also be instrumentalizing if done in a certain way seems to suggest that any technique done with a virtuous intentionality (i.e. humility and hospitality) can be virtuous. But that does not follow. To use an obvious example, the suffering of infertility does not justify baby theft. Nor to most does it justify cloning. The burden of Savage’s argument is to justify certain techniques (i.e., IVF) in a manner that does not fail to offer resources for distinguishing them from more obviously problematic ones. Similarly, the burden of the Catholic Church’s view is to offer a “line” that explains why techniques that cross that line are indeed inherently instrumentalizing.
What is the “line” that separates some techniques as always manipulative / instrumentalizing from those that may be or may not be? The Church’s position on this is clear. Removing procreation from intercourse renders something inherently manipulative / instrumentalizing even when “well-intentioned” (in the vernacular sense). Of course, the linking of procreation and sexual intercourse is presented as a necessary but not sufficient condition of virtuous procreation, since other methods can be vitiated by vicious intentionality.
Now that Beth has reminded us to look at character formation and humility / hospitality with regard to having kids, it may help to employ those same resources in explaining the “line” between what is always manipulative and what may only possibly be such.
Beth, I think you should have given more information about the Savage family’s struggle in your piece.
Sean Savage’s CNN post explains that after the fertility clinic made an error and impregnated Carolyn with another couple’s embryos, Carolyn carried the baby boy to term and they gave the baby to the genetic parents. But that must have been so emotionally difficult for them. If your argument is about character and you are trying to say that the Savages are not a good example of hospitality, I think that is insensitive given the details of their story. They already explain that it was painful for them when the Diocese of Toledo issued a statement saying that IVF is morally unacceptable. Now your piece seems to describe them as inhospitable. I think that a personalist approach would be more charitable than that.
I also think we need to wrestle more with the difficulties of adoption. Adoption–both domestic and international–is very expensive and emotionally draining. And adoption often commodifies the child as well.
Good points, Emily. The Savages most definitely were hospitable in one way–carrying the child of another couple only to give the child up at birth. That decision on their part shows a lot courage as well. I didn’t mention it because, quite frankly, the post was too long, and I wanted to make a point about Artificial Reproductive Technologies more generally, a point which I still think holds even in the tragic circumstances the Savages faced. I think the situation they faced, however, just goes to illustrate how morally problematic IVF really is. Mrs. Savage carried for 9 months a child she promptly had to give up. That child has two mothers now–its genetic/nurturing mother and its gestational mother, and it seems as if the latter is not even included in the child’s life. This seems to me an injustice and a tragedy.
On adoption, you are right, and I point to some of the problems with the way adoption has been talked about by the church in my post. Adoption is expensive, it takes a long time, and most tragically, it often turns the child into a commodity. But this is a danger with parenting in general–it is expensive, it takes a long time, and it frequently turns the child into a commodity. I think that we can work to continue to improve and streamline the adoption process while still seeing the value of the practice in our society.
Finally, I did not mean to be uncharitable to the Savages, but rather to respond to the rather strong argument he himself made on the blog. He thinks the Church’s stance on IVF is unjust and discriminatory (strong language indeed!), but I think the stance he takes risks becoming unjust and inhospitable. I am not trying to attack him, but rather respond, challenge, and disagree.
Beth,
Interesting and light giving. I started following this blog after hearing a talk by Fr. Gula, in which he talked about character based moral thinking. But it bothers me the same way Humanae Vitae bothers me. I am not convinced that the slippery slope argument is an overpowering argument. Yes, Catholics can turn their children into commodities. But as subsequent posts have shown, there is a whole lot more to the narrative, such as their decision to keep the baby incorrectly conceived and give it to the genetic parents.
Over the years, I have known a number of people who have chosen adoption. In many cases, they come to regret it, especially if they adopt older children. I would advise parents who want to adopt that it is no panacea.
I’d love to hear from Beth (and others at CMT) on the development of natural cycle IVF and how this particular technology might shift the conversation. NCIVF doesn’t require the use of hormone stimulating drugs to sync the menstrual cycles. Doctors use the egg the woman’s body would naturally release, only through stimulation of the ovary. While questions around hospitality may still be present, this could be a technology that certain families like the Savages might be able to utilize with the counseling and discernment of their community. I also suspect this may be a very useful technology for families (like my own) who are considering embryo adoption.
http://www.naturalcycleivf.net/green-fertility/get-pregnant-family-planning.aspx
Melissa,
I was actually not familiar with NCIVF until you brought it to my attention, but at first glance, it looks very interesting and promising for couples struggling with conception. Although I have not seen any “official” magisterial treatment of NCIVF, I think it likely that the Church would still say that such a procedure severs the natural connection between sexual intercourse and reproduction. I am not, however, as evidenced by my post, convinced that this is the best line to draw between what we would call moral vs. immoral modes of reproduction. As many of the comments have indicated, completely natural reproduction can commodify the child and become inhospitable, while artificial reproductive technologies need not necessarily commodify the child or become inhospitable.
Speaking of hospitality, I thought of this when writing the post but did not mention it due to space restraints. However, embryo adoption, as you mention you are considering, seems to take hospitality to a new level. In his pastoral letter I quoted in the post, Cardinal Sean O’Malley actually raises the question of the morality of embryo adoption:
Embryo adoption seems a remarkable compromise between the desire to carry a child to term and the Christian imperative to “care for the orphan.” It does not solve the problem of “wanting a child of one’s own,” but it is this desire I find problematic in the first place. Embryo adoption may also be a solution for those couples who desperately want a child but find the adoption process too complicated, expensive, or painful to pursue. I commend you for thinking so critically and creatively about this issue and I urge you to continue commenting on this blog and elsewhere on your discernment process and experiences. It is so helpful for moralists to have first-hand experiences to draw from when analyzing issues like this.