Any consideration of this topic must take place in the context of the Christian view of the sexes, sexual intercourse and marriage.
In Genesis 2:18-25 we learn why God created mankind as male and female and then laid down the aspects of the relationship which would exist between them - companionship (v.l8), support (v.l8), complementary (v.l8), kinship (v.23) and union (v.25). This unitive aspect in sex and marriage is emphasized much more in Scripture than the procreative aspect (illustrated by the fact that it continues long after the couple are capable of becoming parents). The primary purpose in marriage is to unite a man and woman in a loving relationship. Out of this relationship another life may be created, but if we emphasize procreation at the expense of personal union we imply that a childless marriage is a second-rate marriage. This is unjustifiable, and can easily lead to the acceptance of the idea that any technique which results in the conception of a child is acceptable.
A second important principle concerns the rights of a woman or couple to have a child. In our day the rights of individuals are paramount, but in the Bible children are looked upon as a gift from God, not as a couple's right (Psalm 127:3).
About one in seven couples finds difficulty in conceiving children. In approximately one third of cases the problem lies with the man (e.g. a low sperm count), in another third the bar to conception lies with the woman, and in the remainder no specific cause is found. When a couple is eagerly looking forward to starting a family, the failure to conceive often comes as a great frustration and disappointment (cf. Rachel in Genesis 30:1 "Give me children, or I shall die"). Several techniques have been developed to assist couples in having children, and they all raise serious ethical questions for the Christian. The main techniques are briefly summarized below.
- Artificial insemination (AI). The sperm are introduced artificially into the neck of the womb at the time of ovulation. These sperm may be a concentrated sample from the woman's husband (AIH) or have come from a donor (AID) and the technique has also been used to enable women who are not in a heterosexual relationship to have a baby. Both forms of artificial insemination introduce at least one outside party into the marriage relationship - the doctor performing the operation in the case of AIH and also the donor in the case of AID. Donor insemination raises additional problems for Christians in that, although literal adultery has not occurred, the child is conceived outside the marriage bond, the husband is not the biological father and the children may either be denied knowledge of their true parent or have difficulties coming to terms with the means of their conception.
- In Vitro Fertilisation (IVF). When other treatments have failed, couples may be recommended to undergo in vitro fertilization. "In vitro" is Latin for "in a glass" and IVF involves bringing together the sperm and egg outside the body, allowing conception to take place and inserting the embryos in the woman's womb.
The first IVF or "test-tube" birth in England occurred in 1978 and since then approximately 66,000 IVF babies have been born, currently accounting for about 1 % of all the births in Britain every year. However, this underestimates the use of the technique as IVF has a failure rate of about 80%.
In vitro fertilization produces some similar ethical problems to artificial insemination and others which are unique to it. In IVF either the sperm or the egg or indeed both may come from donors, which means that the child conceived is not genetically related to one or both of his/her parents. Another factor in IVF which should cause great concern to all Christians is the policy in most IVF centres of producing spare embryos. The woman's ovary is stimulated to produce a number of eggs at once and after fertilization three or four may be implanted in the hope that at least one will result in a successful pregnancy. However, if two or more of the embryos then implant successfully in the womb the couple may be offered selective reduction to achieve the number of babies that they want at one time. These processes result in many embryos being frozen, discarded or used for research. As tests develop to screen out "undesirable" embryos (e.g. by sex or hereditary abnormality) the expectation of producing only perfect children will increase and we enter the era of "designer babies".
It is possible to perform IVF without creating spare embryos and, if this technique is used along with only the husband and wife's sperm and egg, the ethical problems with IVF are significantly reduced.
- GIFT and POST. There are a number of other less well-known reproductive techniques which can be used, e.g. GIFT (gamete intrafallopian transfer) in which the woman's eggs are removed, mixed with sperm and then placed in the fallopian tubes or, in the case of POST (peritoneal oocyte and sperm transfer), at the end of the tubes. Neither of these techniques involves the creation of an embryo outside the woman's body and so they avoid some of the ethical dilemmas of IVF, although the problem of mixed parentage will still occur if either the sperm or egg do not come from the couple.
- Surrogate Pregnancy. This describes the practice whereby one woman carries a child for another with the intention that the child should be handed over after birth. The child may have been conceived by one of the previously described techniques, and the surrogate mother may receive a payment for her "services". Surrogacy is legal in the UK, but under rules that stipulate that no money should change hands except to cover "reasonable expenses", and advertising for a surrogate is illegal. This practice raises so many ethical issues that it is very unlikely to be even considered by a Christian couple.
In coming to a decision as to whether as Christians we find any of these techniques acceptable we need to address the following ethical issues.
1. In all these techniques fertilization occurs without the act of sexual intercourse.
2. Sperm have to be obtained by methods other than sexual intercourse and all techniques interfere to some extent with the couple's marriage.
3. The use of donated eggs or sperm or a surrogate introduce a third (or even fourth or fifth) party into the marriage - the child is no longer a symbol of the bond between two parents.
4. The use of some of these techniques could cause problems in a marriage at a future date when disagreements occur - "It's not your child anyway."
5. Is a pre-implantation embryo a person or just a lump of cells that can be destroyed, frozen or used for research? What happens to spare embryos? Is pre-implantation testing for genetic diseases a step onto the slippery slope that leads to "designer babies"?
6. Donors, surrogates and children could be open to financial and emotional exploitation.
7. Children have either to be kept in the dark concerning their method of conception or may have difficulty coming to terms with it.
8. These techniques are expensive. Should finite National Health Services resources be used for these treatments and, if not, is it fair that they are only available to those who can afford to pay for them?
Many of the presuppositions which have led to the development of artificial reproductive techniques arise from a non-Christian view of the world, the sexes, relationships and marriage. In this area as in all others, let us endeavour to ensure that we do not let the world "squeeze us into its mould".
This article has been prepared with the help of published material from Care (Christian Action, Research and Education), Christian Medical Fellowship, The Life League and the book "Christian Ethics in Health Care" by John Wilkinson (The Handsel Press).