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Fertility treatment and God

02 May 2014

The Church offers little help to those wrestling with IVF ethics, says Robin Gill


I WAS teaching a module on medical ethics to an interdisciplinary and international group of postgraduate students, a few years ago. Some of the students were religious; others were not. So, although they knew that I was ordained, the contents of my teaching did not presume faith.

After the seminar, one of the students asked to talk to me privately. I swiftly moved from an academic to a pastoral and compassionate role. She said that she was an active Anglican, having belonged to a conservative Reformed church, but dared not talk to her former minister about her problem, and was yet not sure about her present vicar. After several years of marriage without a pregnancy, she was desperate to have a baby and was considering IVF. But she feared that it was sinful.

We talked about the ethical issues raised by IVF, and she went away to think and pray about them. We said no more, but a couple of years later, she gratefully brought her newborn baby to see me.

Traditional Roman Catholics will have a similar dilemma. Their Church's teaching is strongly opposed to IVF, because it is deemed to break the bond between the unitive and procreative functions of sexual intercourse. Yet we know that many Catholic couples resort to IVF. They are unlikely to confide in their parish priest (just as they do not about contraception), and, as day-patients, may never see a hospital chaplain.

The doctors and nurses that they encounter may well feel uncomfortable about discussing issues of faith, and couples may also feel such discussion with them to be inappropriate.

THIS dilemma is compounded by the sheer complexity of some novel forms of IVF. News media have recently highlighted the possibility of so-called "three-parent" babies - sometimes in sensational terms. As a member of the Nuffield Council on Bioethics, I have been privileged to take part in the lengthy ethical discussion that led to its recent report Novel Techniques for the Prevention of Mitochondrial DNA Disorders, which can be found on the Council website (nuffieldbioethics.org), under Publications.

If implemented successfully, these novel techniques should allow a small number of women who carry serious mitochondrial disorders to have healthy babies, using the nucleus from the woman's own egg fertilised by the father and a de-nucleated egg from a donor. It is not thought by the scientists involved that such treatment will affect the identity of the baby, since he or she will receive her active DNA wholly from the mother and father, and not from the donor. The donor will effectively contribute only the mitochrondria (the fragments of DNA inherited from the female line that surround the nucleus).

The first women to receive this form of IVF are likely to know more about it than many health-care workers, let alone parish priests. They may well have already had stillbirths, or seriously disabled children, and be highly knowledgeable about their condition. Like many of us, they will typically have accessed as much web-based information about the treatment as possible - including perhaps the Nuffield Council report.

Knowing some of the doctors who work in this area, I am confident that they will also be given careful counsel, and an explanation of some of the ethical issues involved for them.

THERE are three serious issues in social ethics, however, that may or may not be discussed with these patients. The first involves safety for future generations.

Although, of course, there is safety for the baby and the mother, this is a novel and untested treatment, and the detailed function of mitochondria is poorly understood. Yet it is likely that this particular baby will be much healthier than any child born naturally to the mother, given her genetic condition.

Nevertheless, this mitochondria will be passed on largely unchanged to future generations, and no one can be sure that problems will not emerge for them.

The second issue is that the treatment appears to cross a boundary: genetic engineering, or germ-line intervention (which is illegal in many countries, including Britain). Some worry that it sets a precedent for those who would like to produce so-called trans-humans - superhuman people who have enhanced DNA.

The third issue concerns priorities. Given that the NHS has finite resources, should such novel IVF techniques be given priority for the few, over the standard IVF treatment for thousands of couples, that, until recently, was typically rationed within the NHS to a single cycle?

This last issue is a thorny one for medical ethics; and, as genetic science develops, it is likely to get worse. There are other costly fertility treatments on the horizon that will benefit the few rather than the many. For example, womb transplants are being attempted in a number of countries, allowing those born without a womb, or whose womb has been destroyed, to give birth to their own babies. There are questions of safety for both the woman and the baby about this novel technique as well, since the woman must take powerful drugs to stop her body rejecting the transplanted womb. But once she has completed her family, the transplanted womb can be removed, and the drugs stopped.

ARE couples desperate to have a healthy baby likely to be deterred by such futuristic concerns? And how strongly should those engaged in pastoral care raise such concerns? I do not have any easy answers to these questions. But there are some practical resources that Christian couples can access. Nuffield Council of Bioethics reports explain issues in medical ethics very carefully without using too much jargon.

The Council has always had some members who are active Christians, even though its overall stance is emphatically pluralist. Its reports avoid dogmatic conclusions and allow readers to make up their own minds.

Locating a sympathetic hospital chaplain can also be very helpful. Many chaplains themselves will read Nuffield Council reports, and are likely to sit on hospital ethics committees. They are also trained to listen carefully and not be judg-mental.

In addition, they are likely to know well-informed Christians who could discuss ethical issues with couples (I have sometimes been used in this way by hospital chaplains).

On balance, the Nuffield Council report comes to the conclusion that, provided there is evidence thatthe mitochondrial treatment is unlikely to harm the baby, then it would be right to change the law to allow it.

But in the process of arguing for this position, the report makes clear that there are still many scientific and ethical issues that are unknown - just as there are for womb transplants.

I cautiously share this conclusion. As with many other complex areas in medical ethics, we must first listen carefully to the scientists. Although I speak for neither body, I have sat for many years on the BMA's Medical Ethics Committee, and the MRC's Stem Cell Bank Steering Committee, and have huge respect for medical scientists.

And it is important to engage constructively with medical lawyers, social scientists, and philosophers.

But finally, as a theologian, I must try to follow Jesus in bringing compassionate care to those in need of healing, and encourage doctors to do likewise, whatever their faith. Bringing ethics and pastoral care closer together is, I believe, essential to this theological task.

Professor Robin Gill is the editor of Theology and Canon Theologian at Gibraltar Cathedral.

Rosemary and Kurt Morgan had to make theo­logical decisions about infertility treatments. They have since adopted three siblings

OVER the years, I thought I had a good relationship with God. Then I found God denying my request for a baby.

In the Bible, I could only see references to infertility as something of the past. In particular, I struggled with Genesis 30.22: "Then God remembered Rachel, and God heeded her and opened her womb." If God did not give me a baby, did that mean he had forgotten me?

I met my husband at university, and we started trying for a family as soon as we married. The tests began after about a year: blood tests for hormone levels, checks on ovulation, sperm samples.

My lowest moment involved having an internal exam in hospital. First, I had had to wait in the maternity department, looking at women holding their new babies, or stroking rounded stomachs. Then, at the end of the examination, the doctor said: "Good girl". I wept. I was not a real woman. I was a girl, who could not do this simple, natural thing.

We were offered two free cycles of IVF, if we wanted it. After that, we would be expected to pay.

Making decisions about fertility treatments was confusing and daunting: how were we to know what wasa godly way to undergo fertility treatment? The Bible does not mention IVF or GIFT - donor sperm, or surrogacy as we now understand it. God must have an opinion, but it is not easy to discern his will when our own desires are shouting so loudly.

One of the hardest things was that there was not a lot of guidance in the Church. We badly need to respond theologically to infertility. What does it mean in the eyes of God if you take donor sperm or donor eggs to conceive a child? If you go for IVF, and some embryos are selected, and some "less viable" ones are destroyed, does that mean that you are killing a child, or a potential child?

If these issues had been debated, it would have meant that we would not have been left trying to decide everything on our own. We did not want to "play God"; we did not want to "kill".

We spoke to our minister. It was incredibly embarrassing to discuss the details of treatments and options, such as donor eggs or donor sperm, and I expected to hear bolder statements of belief, more certainty about what was the right or wrong thing to do.

In the end, we had to decide alone which treatments we thought were OK, and which we thought were a step too far. The crunch for us came down to what happens to the embryos that are not used. We ruled a lot of things out, ethically.

The Church needs to respond pastorally and liturgically, too. People were happy to pray that we would be healed, and conceive a child. But when we did not, there were no grieving services to be invited to. We have never been given any space or suggestions as to how to we could mark our sense of loss over the children we have never had.

Everyone would have preferred it if I had had a miracle baby. It would have made everybody's life easier. The science is complicated, and it changes quickly; but if we are sending members of our Church into infertility clinics, I think, as Church, we have to go to go there, too. If that means reconsidering our opinions on a regular basis, then we must do that.

Not being able to have biological children is a great sadness. I have searched for God in the midst of infertility, and although I did not find a fertility god who promises a baby, I did rediscover a God who knows what it is to struggle, whose body failed him, and who knows what it is to long for something. I had an emotional crisis, but not a spiritual one.

Living with Infertility: A Christian perspective by Rosemary Morgan is published by BRF at £7.99 (Church Times Bookshop £7.20).

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