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 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
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
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
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
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
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