By / Feb 23

Earlier this week, University of Alabama at Birmingham (UAB) healthcare system announced that it was pausing all in vitro fertilization (IVF) fertility treatments. This pause is due to the perceived fear of prosecution and lawsuits in light of the Alabama Supreme Court’s ruling on Friday, Feb. 16, stating that human beings in the embryonic stage have the same legal rights and protections as children who are born. 

Barbara Collura, president and CEO of Resolve: The National Infertility Association, released a statement noting that UAB has “been forced to make an impossible decision: pause IVF procedures for those hoping to build their families, or put their patients and doctors at risk of prosecution.” She went on to note that “[t]his cruel ruling, and the subsequent decision by UAB’s health system, are horrifying signals of what’s to come across the country.” UAB spokewoman Hannah Echols said they are “saddened” by the court’s ruling and noted that patients can continue the IVF process up through egg retrieval, though fertilization and implantation must be paused for this time due to the ruling.

What happened in the Alabama Supreme Court ruling?

The move by the UAB healthcare system centers around a case where the Alabama Supreme Court ruled in favor of three couples who sued a fertility clinic in Mobile after a 2020 incident where their frozen human embryos were dropped and destroyed. The court ruled in LePage v. Mobile Infirmary Clinic, Inc. that the state’s Wrongful Death of a Minor Act, first enacted in 1872, also applies to “extrauterine children” even if they are stored in cryogenic freezers. The Justices noted that the location of the unborn child, in or outside the womb, does not matter according to the existing statute.

Justices cited their interpretation of this act as in accordance with the language found in Amendment 2 of the Alabama state constitution which was ratified in 2002. The amendment states that “it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.” The ruling notes,

“Here, the text of the Wrongful Death of a Minor Act is sweeping and unqualified. It applies to all children, born and unborn, without limitation. It is not the role of this Court to craft a new limitation based on our own view of what is or is not wise public policy. That is especially true where, as here, the People of this State have adopted a Constitutional amendment directly aimed at stopping courts from excluding ‘unborn life’ from legal protection.”

This ruling has sent shock waves throughout the country, including the pro-life movement which has historically been torn over the ethics of IVF. 

What is IVF?

IVF has become a routine, albeit financially costly, procedure in many fertility clinics around the world for couples who want children but are unable to conceive by natural means. Doctors often give couples options ranging from various testing, medicinal interventions, and assistance in natural reproduction. If these efforts fail, medical professionals, such as an endocrinologist or an OBGYN, may recommend an IUI (intrauterine insemination) procedure where sperm is collected from the man, cleaned, and then inseminated into the woman at peak fertility via a catheter. If couples choose not to go this route or if it has been tried without success, many will be encouraged by doctors to consider IVF. However, the ethics of the treatment are rarely discussed in great detail with couples—whether in the fertility clinic or even in the Church itself. 

Resolve notes that around 2% of all births in the U.S. employ IVF technologies. The procedure involves the harvesting of ovum from a woman and sperm from a man, both of which are prepared before fertilization of the egg(s) takes place in a lab. Often, but not always, the “best” fertilized eggs are chosen for implantation based on various characteristics. Implantation is not successful for couples every time, thus a couple may choose to keep trying with other human embryos from their “cohort.” Many couples choose to freeze their embryos for possible future use, even if they do conceive. 

The procedure is widely embraced by many, including some Christian couples who desperately want to have children. Many advocates see this procedure as morally good or at least permissible because it can allow couples to conceive. IVF has become so common throughout our society that you likely know someone who has utilized these technologies in hopes of having a family. Many couples have been encouraged by trusted medical professionals to utilize this technology and may not have been aware of the extent of the ethical issues at stake when it was undertaken.

It is vital to note in these conversations about the ethics of IVF that all children conceived through this technology are not only made in the image of God, but should also be seen as good gifts from God. How a child is conceived does not change that fundamental truth. Further, the desire for children is a moral good as designed by God, rooted into the fabric of the created order. Infertility is a widespread reality, affecting 1 in 6 couples today, and is a sad reminder of the devastating effects of the Fall. 

When sin entered the world through Adam and Eve, it infected every part of creation, including our bodies, and introduced death, both spiritually and physically. Now, our bodies regularly get sick or do not function as they were intended, often due to no particular fault of our own. Infertility should be viewed as the tragic reality of living in a world that is broken (Gen. 3) and is a crushing diagnosis for couples who desperately want to have children. This is a difficult and sensitive subject that must be navigated with deep pastoral wisdom and counseling, including helping Christian couples facing these challenges to consider all aspects of this reproductive technology before moving ahead with the procedure.

What are some of the ethical considerations for Christians with IVF?

As already noted, the pro-life movement has historically been divided over the ethics of IVF and this issue must be navigated with wisdom rooted in both truth and grace. The desire for children is inherently good and a gift from God, but the IVF procedure should be concerning for Christians given the Bible’s affirmation of the inherent dignity and value of every human person—from fertilization/conception to natural death.

Many committed to a pro-life ethic are open to IVF as a fertility treatment in certain circumstances, including:

  • Choosing to have only one egg fertilized at a time, ensuring no human life is created and left frozen or discarded; 
  • Embryo adoption, where embryos are donated to other couples desiring children. This is a frontier issue in bioethics that is a moral good in light of the circumstances surrounding how these human embryos were created;
  • No surrogacy or third-party donation of sperm or ovum, which introduces a third party into the marital union. 

Those who disagree with IVF on ethical grounds express deep concern for several reasons, including: 

  • It severs/interrupts the natural union of a man and woman (including the possible use of donor ovum and sperm, introducing a third party); 
  • An abundance of human embryos are often created but are not always implanted. Frequently, they are discarded and destroyed;
  • And, in some cases, the underlying thinking displays a level of hubris that somehow humanity, through our technologies, are empowered to act in the place of God, deciding to create human life and choose which human embryos are given a chance, usually due to extraneous factors. 

Discarding or destroying human embryos is especially problematic. Until recently, many doctors believed that abnormal cell growth in human embryos may negatively affect the success of IVF. Thus, many human embryos were discarded or destroyed before implantation. But even among the “healthy” embryos, a couple often must decide what to do with them if they choose not to implant them. They are generally frozen (in suspended animation) until they are used in another implantation process or saved for the future expansion of a couple’s family. Embryos can also be put up for adoption—in local or national embryo registries for other couples trying to conceive. Sometimes, embryos are even donated for the abhorrent practice of scientific experimentation on human embryos. There are countless variables at play, but the bottom line is that children must never be discarded or destroyed. 

Some pro-life IVF advocates will note that even in natural conception, fertilized eggs do not always implant into the uterine lining of the woman for various reasons. Thus, they conclude that IVF is essentially the same as the natural process yet helps many couples conceive. However, this logic is flawed in that it equates the natural process of conception with the creation of embryos by fertility doctors through substantive human intervention and technological means. While the aim of helping couples conceive is laudable and to be commended, this particular procedure routinely seeks to interfere with the natural process to a degree that human life at the embryonic stage is commonly seen as something made by human hands and, thus, possibly disposable, rather than a gift from God through the miracle of life that is to be received and cherished at all times. It begs the question: Just because we can pursue these technologies, it is something that we should do? 

Life begins at conception, which means human embryos are children; they are human beings made in the image of God. Therefore, we all must seek to protect and honor their lives as we consider the gravity of what our technological developments have wrought—and that includes our best-intentioned efforts to overcome a challenge as heart-wrenching as infertility. Couples facing this can feel isolated or hurt, so it is incumbent on the Church to walk alongside them in this journey as they consider the ethical complexities associated with IVF and understand all possible options to grow their family.

As our family has and continues to struggle with infertility, I identify with the deep desire for children. This is a moral good married couples should pursue, but not by any means available or without adequate moral deliberation. Christians, of all people, must consider the full weight of procedures like IVF in community as we seek to prioritize the family and protect the most vulnerable among us.

By / Aug 25

Recently, the Human Fetal Tissue Ethics Advisory Board released its recommendations for funding based on proposals submitted to the National Institute of Health. This board, tasked with the oversight of projects that would require the use of fetal tissue, recommended that the Health and Human Services Secretary Alex Azar withhold funding from all but one project. This has led to charges that the board is bringing ideology to bear on an objective process. However, the board is made up of experts across the ideological spectrum who weighed the proposals and made recommendations based on the merits or deficiencies of the proposals. 

Background: Defining fetal tissue research and a history of the oversight board

Fetal tissue research is the use of cells “that are harvested for the purpose of establishing cell lines or for use as transplantation material and other purposes.” This process of harvesting cells can be done through induced abortions or from miscarriages, but the mother must consent for the cells to be used in NIH proposals and research. 

The Human Fetal Tissue Research Ethics Advisory Board was announced in June of 2019 when the Trump administration banned the current use of fetal tissue in federally funded projects. Previously, the process had been for grants to go from the National Institutes of Health to the Secretary for final approval. However, with the creation of the new board, previous projects were halted, and all new proposals had to go through an additional layer of ethical review. This board, made up of 15 individuals who meet specific qualifications, and which must be made up of a broad range of experts, considered the ethical ramifications of the research and the necessity of the fetal tissue research. Their recent meeting recommended withholding funds from 13 proposals previously approved by the NIH and the funding of one proposal. It will now be up to Secretary Azar to make the final decision under HHS rules.

The members of the board include scientists, theologians, ethicists, and medical professionals. There are a range of perspectives on the board raging from those opposed to fetal research and those who are advocates of the procedure. One member in particular, Ben Mitchell, should be noted because of his expertise in this area. He is a Southern Baptist bioethicist, a member of the ERLC’s Research Institute, and the former Graves Professor of Moral Philosophy at Union University.

What recommendations were made?

Reviewing the recommendations of the board, there are several things to note about the proposals that were rejected and the one that was approved. Though there is no identifying information about the proposals, it is clear that, despite the ideological diversity of the board, there was not much disagreement on board about most proposals. When comparing the votes, only two of the proposals received relatively close votes. The other 12 ranged from 10-5 to 15-0 voting to withhold funds. So it is clear that on a board containing members across the ideological spectrum, a clear supermajority was reached as to the viability of these studies in almost every case. 

When looking at the reasons that the proposals were rejected, the participants noted a number of problems that caused them to vote as they did. These ranged from procedural and privacy concerns about the research to larger scale questions such as the manner in which the tissue would be obtained, whether another type of tissue could be used, and even the concern that one institution could be profiting from the procurement of the tissue. Also, it should be noted that several members of the board made clear that they would be willing to support the proposal if the problematic uses of tissue were removed or corrected. 

The board voted 9-6 for the proposal they recommended funding. The proposal is for a study of alternatives to fetal tissue and substitutes. In a study of this type, some fetal tissue is necessary as a control group so as to judge the experimental group. However, the recommendation clarifies that this study would be using existing fetal tissue which had been stored rather than acquiring new sources. Thus, it would not run afoul of causing the researchers to participate in abortion or other procedures to procure the samples. and if successful, it would eliminate the need for future research with fetal tissue by providing an alternative. 

How should Christians think about fetal tissue research?

There are several ethical considerations when it comes to fetal tissue research for the Christian. The first is the manner in which the tissue was originally collected. As noted above, fetal tissue can be taken from miscarriages or induced abortions. Christians ought to reject any willful taking of the life of a child for medical research purposes because of the child’s right to life. However, in the cases of miscarriages, there is room for disagreement among Christians about how to use the cells, just as in the case of individuals who donate their organs after death or bodies for medical research.

The other concern is what is to be done with cell lines that are already in existence from previously harvested tissue. Some of these were taken from aborted children, and thus were collected through unethical and immoral means. But does this mean that all research from the stem cell line must be rejected? While there is room for debate in this area, the salient ethical concern is whether an individual is participating in the evil of abortion by benefiting from the research of tissue collected by immoral means. As with vaccines developed with stem cell lines from aborted children, the individual who chooses to receive the vaccine is not morally culpable for the methods used to create the vaccine, but they should pursue ethical vaccine creation with alternatives to fetal tissue. 

In general, Christians should oppose the use of fetal tissue in research because of the way it incentivizes the marketing of aborted human fetal tissue. Though there are ways to obtain the tissue ethically, as with the consent of parents after a miscarriage, it is impossible to avoid the way this practice incentivizes the treatment of children as tools for scientific experimentation. One abortion provider, after intense public backlash following horrific videos detail practices for obtaining the tissue, said that it would no longer attempt to recoup the $45-60 that it receives as reimbursement for the tissue collection. When they made that statement in 2015, that $45 (taking the lower estimate) would have netted the abortion provider, if half of their 140,000 abortions resulted in fetal tissue to be sold, an additional $3 million. Christians should oppose this commodification of children and a Darwinistic worldview struggle that defines individuals by their utility rather than their intrinsic worth.

Ethics, science, and pro-life policies

For these reasons, the ERLC is grateful for the careful consideration the advisory board clearly carried out with respect to the proposals before it. The ERLC applauds the work of the board in ensuring an ethical approach to such a sensitive subject. 

Some detractors of the board have castigated it as a group which has brought ideology to bear on the rational and objective sciences. However, it should be noted that these ethical review boards arise out of a history of scientists objectifying individuals and populations and treating them as subjects for research rather than individuals possessing unique dignity and worth, most notably the notorious Tuskegee Study in the early 20th century. There is a need for ethical oversight when it comes to human research, especially when vulnerable populations are involved. 

Though there are cases where fetal tissue can be obtained ethically, as in the case of miscarriages, there is also the danger of incentivizing the death and sale of children through fetal tissue research. Thus, it is imperative that a board such as this review proposals and ensure that a culture of death is not expanded under the banner of improving life for the rest of humanity. We cannot sacrifice the weakest for our own benefit—that is a Darwinistic outlook that sees power and might as the standard of morality and defines a child in terms of his or her usefulness, not their intrinsic worth. The work that the advisory board is doing helps to promote an ethical approach to research that defends the rights of the most vulnerable.

By / Aug 18

Growing up, I was often surprised that other people did not have as many grandparents as I did. While everyone I knew had four, I had more than double that at nine total. This is because my father and birth mother divorced, and they were themselves the products of blended homes. So to talk about my family tree, I would end up confusing people because I would switch from speaking about my “mother” to my “birth mother” (leading some to think I was adopted). I didn’t know any different, and that was just how my family tree looked. I’m sure it is the same for many people.

What is IVG?

This is a reality that will become even more common in the coming years, but not because of a rise in divorce rates. It’s because of new technology that makes it possible for a child to have two, three, four, or any number of parents. This technology, in vitro gametogenesis (IVG), goes beyond merely assisting couples in reproduction and actually circumvents the very biological processes necessary for fertilization. Thus, while certain artificial reproductive technologies (ARTs) can, in some ways, reinforce the biological reality of sexual complementarity and childbearing, IVG necessarily opens up the floodgates for a complete reinterpretation of sex, family structures, and parenting. 

Before looking at IVG, I should state clearly that most ARTs arise out of a deep desire for children that is godly and honorable. Also, in many cases, individuals turn to these technologies because of the reality that they have been unable to conceive by natural methods or because of a series of miscarriages. This is something that my wife and I discussed at length prior to our marriage because of a series of health concerns which she feared would prevent her from conceiving. Thinking about this topic is different than speaking to someone who is struggling with the thought that they are unable to do the very thing that they desire most in this world. The longing for children is a good and holy desire. It is one of the most devastating effects of sin on our bodies that it is not always possible to fulfill that desire. 

Additionally, there is an entire generation of young men and women who were conceived through IVF. So this is not just a discussion of theoretical concepts, but of the very lives of people that we know, whether that is the child down the street, a friend, or a family member. These are not partial people who possess only a half-dignity because of the manner in which they were conceived. They are full image-bearers. Any discussion of ARTs should bear in mind that this has direct practical application on people’s lives. 

With those caveats about ARTs generally, I would argue that IVG is a different kind of technology and thus is a unique threat to family structure and stability. 

In vitro gametogensis is the process of creating gametes (sex cells) from other human cells, usually stem cells. The process of sex cell creation occurs in the reproductive organs of men and women, with either a sperm cell or egg produced. However, IVG allows individuals to take any cell from any portion of the body—skin, muscle, organ—and through a series of processes create a gamete. Thus, a single individual—or two men, or two women, or four individuals—could have both a sperm and egg produced which could then be fertilized. The possibilities are literally endless for the ways in which this technology could be employed to create children. Thus, my conundrum about the number of grandparents could be easily multiplied so that a future child has three or four biological parents. 

IVG’s threat to the family

This technology represents a unique threat to the family structure because it destroys the very complementarity of sexuality in a way that no other ART has done. Andrew T. Walker and Matthew Anderson do an excellent job of laying out the ethical concerns of other ARTs in their article on IVF, but these technologies at least recognize the complementarity of the sexes and seek to artificially reproduce it. IVF takes the normal combination of the sex cells of men and women and combines them outside the uterus before implanting them. But implicit in this action is the creational reality that it takes a man and woman to produce a child, so even when employed by same-sex couples, there is a need for an outside donor or surrogate to carry the child. 

However, this is not the case with IVG. It is not two individuals who are participating in the conception of a child, but one or any number of people. Thus, the very structure of heterosexual reproduction, and by extension the definition of the family, is threatened by this new technology. Debora Sparr admits as much in her article on IVG by saying that this method could “dismantle completely the reproductive structures of heterosexuality.” On one level, it is impossible to do this because even the combined cells must be transformed into male and female sex cells. But practically, the truth of a man and woman coming together in the sexual union is totally destroyed. 

Again, I want to affirm that the desire for children is good and holy. But, like all such desires, God has created a structure for the proper fulfillment of that desire. IVG not only circumvents but entirely subverts the creational ordinance for men and women to come together and multiply (Gen. 1:28). Though this technology is possible only in mice at the moment, history has shown that humanity has a tendency to surge forward without thinking about the ethical considerations, leading to situations such as one donor who had fathered over 200 children. 

Christians should be the first to urge the surrounding culture to understand that just because something is scientifically possible does not make it good. Just because we can create life does not mean that we are capable of assuming such godlike power with any true measure. And that does not even begin to get at the scientific problems that could arise from meddling with genetics in this way. 

As I recounted in my story, divorce, another threat to family stability, caused me to be confused about my grandparents. And this technology opens the door for even more confusion. Christians should reject this ART, not out of a fear of the future or a luddite rejection of technological innovation, but because it threatens family structure and subverts God’s design and ordering of the cosmos.

By / Jan 29

Phillip Bethancourt: Welcome back to the Questions and Ethics program with Russell Moore. I’m Phillip Bethancourt, and we have an interesting question for you today, Dr. Moore. So, we got a letter here from a pastor in a small, rural church who asks a pretty seemingly simple question, but it gets more complex as the details unfold. “How should our church respond to a single, virgin woman in the church who became pregnant through in vitro fertilization?” So, he goes on with some of the details to say that she came in and spoke to them about feeling a sense of calling from the Lord that she should get pregnant through this method, even though she is single and a virgin and that they discussed it and counseled her through the issues, and then she went ahead and did it anyway. And so, now she is pregnant with child through this form, and they are trying to think through questions like is this something that they should carry out church discipline on, or should they throw a baby shower, or how should they navigate those issues? So, thinking through that type of situation, what type of counsel would you have for them and for our broader audience about how to think through issues related to in vitro fertilization?

RDM: Wow. Well, what I would say about this is okay, let’s step back and unravel what their problem is. First of all, I agree with the counsel that the church gave to this woman at the beginning that a child needs both a mom and a dad. Now, there are situations where children don’t have a mom and a dad because Dad left or because Mom died or there was some sort of bad situation that happened in the life of that child, and then what do we do? We equip and we support those single parents who are seeking to rear their children as best they can within the community of the body of Christ, and that’s a good thing that we ought to celebrate. I would have said to her exactly as this church did, don’t start out this child’s life without a father as an act of your choice and as an act of your will to do this. I also have problems, as I have outlined before, with in vitro fertilization. I think in vitro fertilization severs procreation from the one-flesh union of marriage, and I think there is a reason why God designed procreation to spring from that covenant, faithful love within marriage. There are all sorts of ethical issues that come along with IVF. So, I would have had all the concerns that the church had, maybe even more.

But, the situation they are dealing with now is what do we do now? She went ahead and she disregarded the church’s counsel, the pastor’s counsel, and she became impregnated having this baby. So, what do you do?

Now, I understand also the tension that these pastors feel because you are trying to think well, if we celebrate this are we now incentivizing other people to create families outside of wedlock without mother and father? But I think that that sort of misses the point here.

You know, there was just this morning, I was reading a really fascinating article. There is a newsletter by Ben Domenech called The Transom that I subscribe to. I get it every morning. It’s really well worth your time to subscribe to this. And he had a section where he is interacting with David Frum, who wrote a magazine article about why the abortion rate is falling, and Frum says there are really two reasons for that, and one of them is a reason that social conservatives will like, and another is a reason that social conservatives won’t like. The first reason is because the positive side of the pro-life message started to take root, this message that life is important and so forth. The second reason though, he thinks, is because there is a cultural absence of the stigma of single motherhood. Now, he says social conservatives aren’t going to like that. I mean, remember all the controversy that happened in American culture in 1992 when then Vice President Dan Quayle said that Murphy Brown, who was a sitcom character, was a bad role model because she was having a child out of wedlock. And Ben Domenech says you know, the stigma being removed from single motherhood isn’t really something that we ought to lament because the stigma never really kept single motherhood from happening; instead, the stigma often drove single mothers into isolation, and sometimes that isolation in recent years was the isolation of the abortion clinic.

So, I don’t think this church ought to take any action that is going to even unintentionally signal that we see the life of this child as being a bad thing. This child did not choose the circumstances of his or her birth, and this child is created and made in the image of God. God knit this child together in the womb. And so, they should receive this child with joy and with thanksgiving, even though they didn’t approve of the means that the mom went through in order to conceive her. The mom is not here in a situation of some kind of ongoing unrepentant sin. She is not in some sort of sexual relationship. She is not involved in fornication. She made what I think is a really bad decision, but now the decision has been made.

And so, what do we do? We welcome in those mothers and their children who need the support of the rest of the body of Christ. And there is going to come a time where maybe this woman has a completely different opinion about the decisions that she made. She is going to need the body of Christ around her. And frankly, she is going to need the body of Christ even if she doesn’t ever come to that situation. I don’t think that ministering to her and ministering to this child is going to cause a proliferation of virgin births by sperm donation in your congregation. I think it is very clear this is not what you are talking about when you talk about family and when you talk about mothering and fathering and children. But you can do that. You can talk about what the bible teaches about moms and dads while at the same time not driving this woman and her child away but bringing them in and saying we disagree with you, and we think this is not the right decision that you have made—the act itself is not a clear violation of a biblical norm in the same way that it would have been in some other situations—but we are going to receive you and minister to you.

That’s, I think, the best way that I can think of to navigate this very very difficult situation. But I am going to acknowledge to you it is a very complex and complicated situation. But I just think we have to be those congregations where we are probably not going to have a lot of these situations, but what we are going to have are a lot of women who are watching our congregations to say how will they receive me if I come forward and say I need help? So, your more typical situation is going to be with unwed mothers who become pregnant the old fashioned way, and a lot of those women are looking around and saying wait a minute—some of them in your communities think if I go to that church and I say I am pregnant the response is going to be oh my word! She must have had sex! You know, and get out of here, harlot! They think that’s what’s going to be the response of the church. Now, you and I both know there are very few churches that are going to respond that way. They are going to love those women. They are going to love the children. But they need to see examples of that happening in the congregation, of women who have conceived children where the congregation is saying look, we don’t agree with the sin behind this, but this child is not a symbol of sin. This child is made in the image of God and needs to be received and needs to be ministered to. That’s my thoughts on it.

PB: Thanks for joining the Questions and Ethics Program. If you have a question you would like Dr. Moore to answer, email it to [email protected], and we will be back again to help you apply the gospel to the pressing issues of the day.