Thursday, October 27, 2011

Dr Megan Best on 'A Christian Approach to Assisted Reproductive Technology'

Dr Megan Best is a palliative care specialist but has been seeking to research and promote a Christian understanding of Assisted Reproductive Technology having been approached a number of years ago to work with the ethics advisory committee for Sydney Anglicans. She has a book coming out on the topic but here are my notes from a lecture Dr Best gave at the Moore College 'Centre for Christian Living' lecture earlier this week.

Dr Megan Best - 'A Christian Approach to ART'
ART - Assisted Reproductive Technology. Medical intervention which assists in the production of children. Most common is IVF. How should we think about the making of "test tube babies"?

Gen 1:28 "Be fruitful and increase in number; fill the earth" Is this reproduce at all costs? Are there limits?
  • We are free to act within limits of God's design
  • Free to pursue healing of our bodies which makes child-bearing difficult.
  • But not "at any cost"
Goal: Framework for thinking, then application to common procedures.

1. Biblical view of marriage
Children created through sexual relationship within marriage between man and woman.
Christian marriage - Gen 2:24. Marriage is a new creative act of God.
  • Unitive (Gen 2:24)
  • Procreative (Gen 1:28)
What is the link to sex in marriage? RC says they must be combined, that only sex that is unitive AND procreative is right. Protestants recognise importance of both, and say both apply in marriage.

The command is repeated in Gen 9, so to fill and subdue continues. Not all couples can procreate (as recognised throughout the Bible), but it is the norm. Through children Gen 5 the image of God is perpetuated, and the blessing of God achieved.

Scripture teaches that the family is subordinate to the marriage. Emphasis in Gen 2 is on man and woman, and thus marriage is a valid end in itself. Desire to have children should not destroy marriage, as they aren't promised. Children should be extended same love and hospitality we have been shown, but conviction is to stand as couple no matter what.

Christians see children as opportunity to raise godly children to witness to next generation, not just perpetuating gene pool, and so need to think of responsibilies not rights.

2. Responsibilities of parenthood
  • To be Godly example to their children and witness to the next generation (Gen 18:19, Deut 6:7)
  • To nurture (1 Jn 3:11-16)
  • Material provision (1 Tim 5:8)
  • Kinship (OT genealogies, Joshua 4:4-7, 20-24) Our very existence is dependent on family line e.g. shown in adopted chilren knowing their parents.
Infertility is painful and often unexpected. It is only as infertility occurs that Christians understand just how much they have no control. Pain increased as infertility a taboo subject. The bible validates the pain of childbirth by comparing it to natural disasters Prov 30:15–16. In a funny way ART has increased anxiety, as there is now another big stress for Christians regarding intervention.

Lots of reasons to procreate. As a blessing of God, it is good to desire children. To those to whom it is denied, there is pain of loss. Difficult to understand why God would withold children from those who desire it (though not the focus of tonight). The desire for this good blessing is what makes the pull of ART so strong and increases anxiety.

3. Moral status of the human embryo
Does it matter how we treat an embryo? Firstly we need a biology lesson

Embryo is 1-8 weeks, then called a foetus. If a baby is a human, when did it start being a human? As everything is available in the first cell, and it is self-directing from that point, at that point life begins. We are dealing with a human being from the time of fertilisation. All professionals accept the self-directing and unique structure of the embryo from fertilisation. It is unified whole, not just collection of cells.

What does Bible tell us about development in the womb?
  • Conception linked to birth - Gen 4:1; Isa 46:3; Matt 1:18
  • Relationship with God while in the womb - Ps 139; Job 10; Ps 51:3
  • The incarnation of Jesus - Jesus' human existence began at conception - Phil 2:7-8
  • All humans bear the image of God - Gen 1:26-27, 9:6
  • Do not kill - Ex 20:13
  • Legal recognition of unborn child - Ex 21:22-25
To get involved in ART, need to have conviction to protect life from beginning.

4. Morality of individual ART procedures
ART is lucrative business, and not all providers are altruistic.
It is not wrong for Christians to seek medical intervention to fix things that are broken. But not ALL methods are acceptable if we want to protect life from its beginning. But reason for infertility will determine what form of ART is used and thus acceptable. Egg/sperm on their own not human, don't need protecting.

IUI - simple remedy to get sperm/egg to unite. Simply bypasses fallopian tubes - though an otherwise intimate activity now involves others. Still two week wait to know if there is a pregnancy. The only issue here is in how the sperm is actually collected - whether with pornography by masturbation or not. Some Christians have problem with masturbation, but most don't. Lust for other than spouse is a problem. Alternatives won't be offered, so need to be forceful. Many clinics allow those who live close by to collect at home. There are alternatives available regarding collection, so ask.

IVF - First and most common form of ART. Basic IVF involves single egg and thus no destruction of embryos. Again, fallopian tubes are just bypassed, and so no huge ethical concerns. But more commonly, IVF is combined with ovarian stimulation to produce more eggs, so that more than one can be harvested. Best case is 25% success for someone who walks into an ART centre. Ovarian stimulation can be used for those not doing IVF, but who can't naturally ovulate. Some dangers involved in this procedure. No ethical reasons per se for hormone use, but if all eggs fertilise, the problems of freezing embryos arises.

Freezing came about to increase success rates for patients and to avoid danger of ovarian stimulation. It is not expected all fertilised eggs will produce to live birth. Generally only 80% even fertilise. In most countries embryos not allowed to exist outside body after 14 days and must be destroyed or cryopreserved. 50-90% don't survive defrosting, depending on clinic (Note: This percentage is questioned later in question time as not in line with what people have been told). There is no formula that x number of embryos lead to x live births. You could have 12 embryos and none lead to live birth, or to 12. They usually look for those that look best, but there is no definite criteria for which ones will go best just by looking at them. Those that look best have no definite link to which will develop. Last year a baby was born from an egg which had been frozen for 20 years time. Only allowed to freeze for 5 years in most states (Note: this is also addressed later in questions).

Is it morally permissible to freeze humans if embryos are humans? This is the most difficult question in the whole business. The basis of Christian ethics is love for God and our neighbour. If we believe an embryo is human, a Christian will give each embryo the best chance at life. Every embryo that is fertilised should be transferred to a womb at some stage. A completely healthy couple having children naturally will have 50-70% of women who have embryos that fertilise but not implant. So for whatever reason God has chosen in the creation of children to build into the process some form of fertilsation which does not lead to a baby being born. The only reason for not transferring embryo is that it is dead. Easier to tell this at blastocyst (5 days) rather than at day 3. Arguments against freezing is that it is unnatural - that unnatural is immoral, but natural theology is based on human reason of what is natural/unnatural, and being after fall this ethic is confusing and not necessarily biblical. Slippery slope is a non-argument as we are down bottom of slope anyway. Further questions for freezing: What if couple gets divorced or one partner dies?

ICSI - Discovered by accident when needle slipped. Sperm injected directly into egg, rather than simply placed together. Used when sperm aren't mobile. Male offspring from ICSI tend to have genetic issues and higher infertility, probably arising from the scientist choosing sperm not the strongest.

Donor Gametes (Sperm and Eggs) - Can't buy human tissue in Australia so need to advertise. Big problem in terms of the family, as third or fourth person are added into the marriage relationship. A common problems with lack of equality in marriage, and husbands can find it difficult, creating tension. Problem also with offspring not knowing their heritage.

Embryo Biopsy
Genetic screening is problematic as it is making judgment on value of life. This does not protect embryos. (Note: Rob Forsyth was interviewed on 702ABC in Sydney that a friend at Bible study was talking about and apparently he had a great line on choosing the sex of your child something like 'A child is created from the parents, not for the parents')

Surrogacy - Lots of problems!!

Summary: Even if ethically okay, might not be okay for you. Lots of costs involved in treatment, physical risks primarily for women. Brings strangers into procreation and not the intimate activity its meant to be. Many find the process dehumanising. Emotionally traumatic. Time consuming. Will doctor help me overcome my ethical concerns, will I be happy to put my foot down. Success rate is still very small ~20% even in the best clinics. Need to set a stop time before you start. Is it worth the cost to your marriage?

Qns:
Egg collection? Early stage of technology. Once this process is improved it will decrease many of the issues, but big loss of eggs, and very very expensive, especially if clinic knows you are doing it for ethical reasons (as opposed to say having cancer treatment which will make a woman infertile).

Qn: Loss of eggs from defrosting? Freezing blastocysts (Day 5) has better defrosting rate than those frozen at day 3, and it's because less survive and growing them to this stage is picking the strongest. Interestingly, recent research suggests that even those that don't survive freezing stage would never have made it. (Note: I was wondering how this research would be possible, but I assume they are saying that eggs implanted which survive freezing have a much higher percentage chance of implantation compared to those which are transferred before freezing.)

What happens to Christian couples who want to continue having embryos transferred after the five year limit on holding eggs expires? Many people delay making the decision on what to do with remaining embryos, so many just refused to make a decision and then stopped paying their fees. The five year limit on holding eggs is so clinics could cease having to pay the storage cost for those who refused to make a decision on their embryos, and had ceased to have any contact with the fertility specialist. The 5 years starts after a clinic loses track and a couple are no longer actively involved in fertility treatment. There is actually no limit on how long an embryo can be stored for, and companies will not destroy embryos of those who are still actively involved in treatment and/or continue to pay for storage.

Embryo adoption? In early stage. Better than gamete adoption. Shows love for the embryo. Generally a good thing. Interestingly, and sadly, most parents would prefer their embryos used for research rather than donated to a couple.

Research on ART offspring? No long term studies, but it is generally known children want to know thier origins. Donor offspring see that the whole industry is about the parents rather than the children. The anonymity makes them upset. Many children are pleased to know the lengths their parents went to, to have them. However, anonymity and where it comes out later in life is a problem.

2 comments:

  1. Just a question, Zac: "sadly, generally parents would prefer their eggs used for research rather than donated to a couple."

    Is that meant to read 'embryo' rather than 'egg'? Not saying I know, it's just confusing me within the context you've got there.

    Cheers for the post bro.

    ReplyDelete
  2. Yep that was a typo. I have fixed it now.

    ReplyDelete