STATEMENT DD135

BRAVE NEW FAMILIES?:

The Ethics of the New Reproductive Technologies

by Scott B. Rae

Summary

The new reproductive technologies give great hope to infertile couples and make
many new reproductive arrangements possible. They also r aise many difficult
moral issues. Artificial insemination by husband is considered moral, but
artificial insemination by donor raises questions about a third party entering
reproduction. In vitro fertilization is acceptable within limits: the couple should
ensure that no embryos are left in storage and that the risk of selective
termination is avoided. Commercial surrogate motherhood raises problems
because it is the equivalent of selling children, can be exploitative of the
surrogate, and violates a mother's fundamental right to raise her child. Even
altruistic surrogacy raises questions about the degree of detachment the mother
must have from her unborn child to successfully give it up after birth.

On March 27, 1986, Mary Beth Whitehead gave birth to a li ttle girl whom she named Sara. That same day, Elizabeth
and Daniel Stern named the same baby Melissa. Both were convinced that the child (called Baby M in the press)
belonged to them, and both were prepared to take drastic measures to win custody over what they thought was their
child. The Sterns had hired Whitehead to bear their child. She was, and is to this day, the most publicized person to
perform the role of a surrogate mother. Their contest over that child was carried on in court for almost two years , and
it illustrates the potential problems and complexities involved with many of the new reproductive technologies.

Medicine has made some remarkable advances in the field of reproductive technology. The term reproductive
technology refers to various medical procedures that are designed to alleviate infertility, or the inability of a couple to
produce a child of their own. These include artificial insemination, in vitro fertilization (or "test -tube" babies), and
surrogate motherhood. When successful, these technologies are the miracle of life for couples who have often spent
years trying to have a child, and who have exhausted all other avenues for conceiving a child of their own. But many
of these techniques raise major moral questions and can create th orny legal problems that must be resolved in court.

These new technologies make possible all sorts of interesting childbearing arrangements. Here is a sampling of what
is now possible for couples contemplating parenthood in unconventional ways:

(1) A man who cannot produce sperm and his wife want to have a child. She is artificially inseminated with sperm
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from an anonymous donor, conceives, and bears a child.

(2) A woman who cannot produce eggs and her husband want to have a child. They hire a woman t o be inseminated
with the husband's sperm, and she bears the child for them.

(3) A woman is able to produce eggs but is unable to carry a child to term. She and her husband "rent the womb" of
another woman and she gestates an embryo that was formed by la boratory fertilization of the husband's sperm and
his wife's egg.

(4) A lesbian couple wants to have a child. One of the women provides an egg, and after it is fertilized by donor
sperm, the embryo is implanted in the uterus of her partner.

(5) A couple desiring to have children cannot produce any of the sperm or eggs necessary for conception. So the
woman's sister donates the egg and the man's brother donates sperm. Fertilization occurs in vitro, that is, outside the
womb, and the embryo is transferred to the wife of the couple, who carries the child.

As mentioned above, these new reproductive technologies raise complicated issues, not only for the law, but also for
morality. What is society to say to these technologies that, in many cases, redefine t he family and turn traditional
notions of reproduction upside down? In addition, since many of these issues are not directly addressed in Scripture,
in what way does the Bible speak to these issues?

ARTIFICIAL INSEMINATION

Artificial insemination is a relatively simple procedure in which sperm, either from the woman's husband or a donor
(if the husband is unable to produce sperm), is inserted into the woman's uterus directly rather than through sexual
intercourse. It is normally the first infertility treatment a couple will try because it is simple to accomplish, involves
no pain for the woman, and is inexpensive compared to other reproductive technologies. It is most often employed
when a woman's husband has a low sperm count, or his sperm has difficulty in reaching the woman's egg.

When the woman's husband's sperm simply needs help in fertilizing the egg, artificial insemination by husband
(AIH) is performed. Most people have no moral difficulty with such a procedure. It is simply viewed as medical
technology providing assistance to what could not be accomplished by normal sexual intercourse. The genetic
materials that are combined when conception occurs (and frequently it takes more than one insemination for
conception to occur) belong to the woman and her husband, and they are the ones who plan to raise the child. Most
people agree that there are no morally significant differences between AIH and procreation by intercourse. The
exception to this is the Roman Catholic tradition, which views most reprodu ctive interventions including
contraception as a problem (see below).

There are many cases, however, in which the husband is not able to produce sperm at all. In these cases, instead of
artificial insemination being performed with his sperm, a donor provides the sperm. This is called artificial
insemination by donor (AID). The donation is almost always made anonymously so that the father cannot be traced
by the child, nor can the father elect to make contact with the child, potentially disrupting a ha rmonious family. In
most cases, the sperm of two or three donors is mixed together, thus making it easier to conceal the identity of the
father.

AID raises ethical questions that are not raised by AIH. Since AIH takes place between husband and wife, the
integrity of the family is maintained, and there is continuity between procreation and parenthood. But AID
introduces a third party into the reproductive matrix, and someone who donates sperm to be used for AID is now

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contributing genetic material without the intent to parent the child that will be produced through the use of his
genes.

The assumption of Scripture is that children will be raised by the people to whom they are genetically related. The
Bible assumes the concept that only husband and wife wi ll be parents of children. There is a continuity between the
genetic and social roles of parenthood. The Bible never clearly defends this notion; it simply assumes it. Perhaps the
reason for this is that it is a notion that does not need defending, similar to the doctrine of the existence of God.

Of course, Scripture could not directly address situations in which these reproductive technologies were available. But
even though techniques like AID are not the subject of direct biblical teaching, there are bi blical principles that can be
applied to these different methods of alleviating infertility. Christian tradition on the family, for example, has always
assumed that children will be born into a stable family setting of monogamous marriage in which sexual r elations
between father and mother result in the child's birth. The principles underlying such an assumption are the integrity
of the family and the continuity between procreation and parenthood. Adoption is widely recognized as an exception
to the general rule, or an emergency solution to the tragic situation of an unwanted pregnancy. Just because the
exceptional case is allowed, however, that does not justify it as the norm.

Catholicism and Natural Law

The Catholic tradition of natural law (i.e., basing morality on the natural tendencies or function of a thing) has also
emphasized the continuity between procreation and parenthood, even to the point of denying the moral legitimacy of
contraception, something that clearly interrupts that process. This is a lso the basis for Catholic opposition to abortion
and most reproductive technologies. If everything progresses as God designed it, sexual relations result in conception
and childbirth. In the same way that God designed an acorn to grow into an oak tree, He likewise designed sexual
relations to come to fruition in the birth of a child. Thus there is a God -designed, natural continuity between sex in
marriage and parenthood. Every sexual encounter has the potential for conception, and every conception has the
potential for childbirth and parenthood. This is why sex is reserved for marriage, and why Catholic tradition makes
little room for any reproductive technology that would interfere with a natural process that is the result of creation. It
also rules out any third party involvement that would replace one of the partners in the married couple.

The most recent Vatican statement on reproductive technology put it this way: "The procreation of a new person,
whereby the man and the woman collaborate with the pow er of the Creator, must be the fruit and the sign of the
mutual self-giving of the spouses, of their love and fidelity....marriage and....its indissoluble unity [provide] the only
setting worthy of truly responsible procreation." 1 In other words, only in marriage is it morally legitimate to procreate
children. A further statement clarifies the unity of sex and procreation, thereby ruling out most technological
interventions for infertile couples: "But from a moral point of view procreation is deprived of it s proper perfection
when it is not desired as the fruit of the conjugal act, that is to say, of the specific act of the spouses' union....the
procreation of a human person [is to be] brought about as the fruit of the conjugal act specific to the love betwe en
persons.2 In other words, there is a unity between sexual relations and procreation. Procreation cannot occur apart
from marital sexual intercourse, and every conjugal act in marriage must be open to procreation as the natural result
of God's creation design.3

For non-Catholics it may be problematic to assume that what is natural is also what is moral. This is what is known as
the "naturalistic fallacy." One cannot necessarily make the leap from the natural to the moral. As the British
intuitionist philosopher G. E. Moore has suggested, what is natural is natural; nothing more and nothing less.

A further problem with restrictions on reproductive technologies is that such restrictions may not be consistent with
God's creation mandate given to mankind t o exercise dominion over the earth (Gen. 1:26). God gave mankind the

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ability to discover and apply all kinds of technological innovations. It does not follow, of course, that mankind has
the responsibility to use every bit of technology that has been disco vered (e.g., certain types of genetic engineering,
nuclear weapons technology). But for the most part, technological innovations that clearly improve the lot of
mankind are considered a part of God's common grace, or His general blessings on creation, as o pposed to His
blessings that are restricted to those who know Christ personally. It would appear that many of the reproductive
technologies in question fit under the heading of common grace, and whether or not they should be used depends on
whether such use violates a biblical text or principle.

IN VITRO FERTILIZATION (IVF)

On July 25, 1978, Louise Brown was born. She was the first child ever born through the use of in vitro fertilization;
that is, she was the first "test-tube" baby. A British gynecologist, Dr. Patrick Steptoe, and a physiologist, Dr. Robert
Edwards, successfully joined egg and sperm outside the body, then implanted the embryo in the mother. Nine
months later, Louise Brown was born and was heralded as a miracle baby around the world.

In vitro fertilization simply means fertilization "in glass," as in the glass container of a test tube or petri dish used in a
laboratory. The procedure involves extraction of a number of eggs from the woman. To do this she is usually given a
drug that enables her to "superovulate," or to produce more eggs in one cycle than she normally does. The eggs are
then surgically removed and fertilized outside the body in the laboratory, normally using the sperm of the woman's
husband. Since the procedure is so expensive ($10,000 the extraction of the eggs being the most expensive part of
the process), all of the eggs are fertilized in the lab. In this way if none of the fertilized embryos are successfully
implanted, reimplantation can occur without much additional c ost or lost time, since to extract the eggs would
involve waiting until at least the woman's next cycle. Normally, more than one embryo is implanted in the woman's
uterus, since it is uncertain how many, if any at all, will be implanted successfully. The a ctual number implanted
depends on various factors relating to the condition of the eggs and the health of the woman. It is not unusual to have
some if not all of the embryos spontaneously miscarry.

If more than one embryo does successfully implant, then the couple may end up with more children than they
originally intended. Twins and even triplets are not uncommon for couples who use IVF. Lest one think that IVF is
successful more often than not, however, the average success rate is less than 10 percent o f the fertilized embryos
actually implanting and developing into a child.

In order to keep the procedure as cost-effective as possible, embryos are frozen in storage to be used later if the first
attempt fails. In some cases, however, more embryos succes sfully implant than the woman is able to carry without
endangering her health and at times even endangering her life.

Concerns about IVF

Both of the above possibilities (embryos in storage and having more children in utero than the woman can safely
carry) raise significant legal and moral issues about IVF. For example, what happens if, during the time in which the
embryos are in storage, the couple divorces and a "custody" battle ensues over the unused embryos? A case like this
was recently resolved in court in Tennessee. A couple who had utilized IVF later were divorced and the woman
wanted to use the embryos to have a child. Her ex-husband refused, claiming that he did not want his progeny
running around without his knowledge even of their existence. Th ey went to court to have their dispute arbitrated.
The court ruled in favor of the ex-husband, holding that one's procreative liberty also gives one the freedom not to
procreate, and thus the embryos could not be used without the man's consent.

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What to do with frozen embryos if they are not needed raises significant moral issues. The alternatives would appear
to be to keep the embryos in storage indefinitely (at a cost of around $150/year), to destroy them, to allow the couple
to donate them to another infertile couple, or to use them for experimental purposes.

Since, as most Christians believe, the right to life is acquired at conception, destroying embryos or using them in
experiments is problematic. Destroying embryos outside the body is the moral equ ivalent of abortion, and science
cannot experiment on someone with basic human rights without that person's consent, particularly since
experimentation on the embryo would result in its destruction. Storing the embryos indefinitely only postpones
dealing with this issue. That leaves donation of the embryos as the only viable alternative. Yet this is problematic too
since it involves a separation of the biological and social roles of parenthood that is a significant part of the biblical
teaching on the family.

It might be possible, however, to view embryo donation in a way that is parallel to adoption as a preimplantation
adoption in which the couple who contributed the genetic materials to form the embryo consent to give up parental
rights to their child before implantation instead of after the child's birth. This would require a significant change in
the adoption laws of many states, since they frequently do not recognize any consent to adoption as valid and legal
until a period of time after the child's birth. These difficulties should cause Christians to think twice before utilizing
IVF.

A second problem arises not from the failures of implantation, but from its successes. As noted above, more embryos
are routinely implanted than will survive in the uterus. But occasionally a woman is left with more developing
embryos than she can carry to term without risk to her health and life. In these cases, the woman and her husband
and her doctor have very difficult decisions to make. When this happens the docto r will normally recommend what
is called selective termination of one or more of the developing embryos. This is done not for convenience' sake, but out
of a genuine concern for the life of the mother. Not only does this involve trading one life or more (t he developing
child[ren]), but the doctor is faced with the decision of which one(s) to terminate and how to make that decision. If
the mother's life is clearly at risk in carrying all the unborn children to term, then it would appear justified to
terminate one or more of the fetuses in order to save the life of the mother. This is analogous to cases in which
abortion is justifiable when carrying the pregnancy to term would put the mother's life at grave risk. However, the
agony of making such painful decisions must surely be considered prior to utilizing IVF to alleviate infertility.

To avoid these dilemmas, a couple using IVF should request that only the number of eggs be fertilized that the couple
will actually have implanted. In addition, they should r equest that only the number of embryos be implanted that the
woman could carry safely should all of them successfully be implanted.

SURROGATE MOTHERHOOD

Undoubtedly, surrogate motherhood is the most controversial of the new reproductive technologies. In many cases,
the surrogate bears the child for the contracting couple, willingly gives up to them the child she has borne, and
accepts her role with no difficulty. In those cases, the contracting couple views the surrogate with extreme gratitude
for helping their dream of having a child come true. The surrogate also feels a great deal of satisfaction, since she has
in effect given a "gift of life" to a previously infertile couple. But in some cases that have been well publicized in the
media, the surrogate wants to keep the child she has borne and fights the contracting couple for custody. What began
as a harmonious relationship between the couple and the surrogate ends with regrets about using this type of
reproductive arrangement.

Surrogacy itself is not new. The Old Testament records two incidents of surrogacy (Gen. 16:1 -6; 30:1-13), and it
appears that use of a surrogate to circumvent female infertility was an accepted practice in the Ancient Near East 4

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What makes today's surrogacy new is the presence o f lawyers and detailed contracts in the previously very private
area of procreation.

Today, surrogacy does not normally involve any sophisticated medical technology. Normally conception is
accomplished by artificial insemination, though in some cases in vitro fertilization is used to impregnate the
surrogate. In the latter cases the contracting couple normally provide both sperm and eggs, so that the surrogate
mother is not the genetic mother.

Problems With Surrogate Motherhood

Surrogacy Involves the Sale of Children. Certainly the most serious objection to commercial surrogacy is that it
reduces children to objects of barter by putting a price on them. Most of the arguments in favor of surrogacy are
attempts to avoid this problem. Opponents of surrogac y insist that any attempt to deny or minimize the charge of
baby-selling fails, and thus surrogacy involves the sale of children. This violates the Thirteenth Amendment that
outlawed slavery because it constituted the sale of human beings. It also violates commonly and widely held moral
principles that safeguard human rights and the dignity of human persons, namely that human beings are made in
God's image and are His unique creations. Persons are not fundamentally things that can be purchased and sold for a
price. The fact that proponents of surrogacy try so hard to get around the charge of baby -selling indicates their
acceptance of these moral principles as well.

Rather than the debate being over whether human beings should be bought and sold, it is over whether commercial
surrogacy constitutes such a sale of children. If it does, most people would agree that the case against surrogacy is
quite strong. As the New Jersey Supreme Court put it in the Baby M case, "There are, in a civilized society, some
things that money cannot buy....There are values...that society deems more important than granting to wealth
whatever it can buy, be it labor, love or life." 5 The sale of children, which normally results from a surrogacy
transaction (the only exception being cases of altruistic surrogacy), is inherently problematic. This is so irrespective of
the other good consequences the arrangement produces, in the same way that slavery is inherently troubling, because
human beings are not objects for sale.

Surrogacy Involves Potential for Exploitation of the Surrogate. Most agree that commercial surrogacy has the
potential to be exploitative. The combination of desperate infertile couples, low income surrogates, and surrogacy
brokers with varying degrees of moral scruples raises the prospect that the entire commercial enterprise can be
exploitative. But statistics on the approximately six hundred surrogacy arrangements to date indicate that this
potential for exploitation has not yet materialized. Most surrogates are women of average means (the average income
being around $25,000 per year), 6 not destitute but certainly motivated by the money. The fee alone should not be
considered exploitation but rather an inducement to do something that the surrogate would not otherwise d o. Money
functions as an inducement to do many things that people would not normally do, without being exploitative.

This does not mean, however, that the potential for exploitation should be discounted. Should surrogacy become
more socially acceptable, and states pass laws making it legal, it is not difficult to imagine the various ways surrogacy
brokers might attempt to hold costs down in order to maximize their profit.

One of the most attractive ways in which this could be done would be to recruit su rrogate mothers more actively
from among the poor, in this country, and particularly from the third world. For example, some are suggesting that
those with financial need actually make the best candidates for surrogates since they are the least inclined to keep the
child produced by the arrangement. 7 Others are making plans to actively recruit women from the third world to be
brought to the United States to serve as surrogates. The advantage to using these women is that it dramatically
reduces the cost of running the surrogacy business.

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John Stehura, of the Bionetics Foundation, stated that the surrogates from these countries would only receive the
basic necessities and travel expenses for their services. Revealing a strong inclination toward exploitation of the
surrogates, he stated, "Often they [the potential surrogates] are looking for a survival situation something to do to
pay for the rent and food. They come from underdeveloped countries where food is a serious issue." But he also
added that they make good candidates for surrogacy: "They know how to take care of children.... it's obviously a
perfect match." 8 He further speculates that perhaps one-tenth of the normal fee could be paid to these women, and it
would not even matter if they had some other health problems as long as they had an adequate diet and no problems
that would affect the developing child. 9

Stehura's comments are representative of the fact that the potential for crass exploitation of poor women in desperate
circumstances is already being seriously considered by brokers in the industry. It is not clear the degree to which
these statements are representative of the entire industry. But with the profit motive being a primary factor it does
not take much imagination to envision the abus es that could easily proliferate.

Surrogacy Involves Detachment from the Child in Utero. One of the most serious objections to surrogacy applies to
both commercial and altruistic surrogacy. In screening women to select the most ideal surrogates, one look s for the
woman's ability to give up easily the child she is carrying. Normally the less attached the woman is to the child the
easier it is to complete the arrangement. But this is hardly an ideal setting for a pregnancy. Surrogacy sanctions
female detachment from the child in the womb, a situation that one would never want in any other pregnancy. This
detachment is something that would be strongly discouraged in a normal pregnancy, but is strongly encouraged in
surrogacy. Thus surrogacy actually turns a vice the ability to detach from the child in utero into a virtue.

Should surrogacy be widely practiced, bioethicist Daniel Callahan of the Hastings Center describes what one of the
results would be: "We will be forced to cultivate the services of wome n with the hardly desirable trait of being willing
to gestate and then give up their own children, especially if paid enough to do so.... There would still be the need to
find women with the capacity to dissociate and distance themselves from their own chi ld. This is not a psychological
trait we should want to foster, even in the name of altruism." 10

Surrogacy Violates the Right of Mothers to Associate with Their Children. Another serious problem with
commercial surrogacy might also apply to altruistic su rrogacy. In most surrogacy contracts, whether for a fee or not,
the surrogate agrees to relinquish any parental rights to the child she is carrying to the couple who contracted her
services. In the Baby M case, the police actually had to break into a home to return Baby M to the contracting couple.
A surrogacy contract forces a woman to give up the child she has borne to the couple who has paid her to do so.
Should she have second thoughts and desire to keep the baby, under the contract she would neverthele ss be forced to
give up her child.

Of course, this assumes the traditional definition of a mother. A mother is defined as the woman who gives birth to the
child. Society never before needed to carefully define motherhood because medicine had previously n ot been able to
separate the genetic and gestational aspects of motherhood. It is a new phenomenon to have one woman be the
genetic contributor and a different woman be the one who carries the child. There is debate over whether genetics or
gestation should determine motherhood. But in the great majority of surrogacy cases, the surrogate provides both the
genetic material and the womb. Thus, by any definition, she is the mother of the child. To force her to give up her
child under the terms of a surrogacy c ontract violates her fundamental right to associate with and raise her child. 11
This does not mean that she has exclusive right to the child. That must be shared with the natural father, similar to a
custody arrangement in a divorce proceeding. But the rig ht of one parent (the natural father) to associate with his
child cannot be enforced at the expense of the right of the other (the surrogate).

As a result of this fundamental right, some states that allow a fee to be paid to the surrogate do not allow th e contract

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to be enforced if the surrogate wants to keep the child. In these states, any contract that requires a woman to agree to
give up the child she bears prior to birth is not considered a valid contract. This is similar to the way most states deal
with adoptions. Any agreement prior to birth to give up one's child is not binding and can be revoked if the birth
mother changes her mind and wants to keep the child. Many states that have passed laws on surrogacy have chosen
to use the model of adoption law rather than contract law that essentially says "a deal's a deal."

The problem with allowing the surrogate to keep the child is that it substantially increases the element of risk for the
contracting couple. They might go through the entire process and end up with shared custody of a child that they
initially thought was to be all theirs. To many people, that doesn't seem fair. But to others is it just as unfair to take a
child away from his or her mother simply because a contract states that she must.

AN ONGOING DISCUSSION

These new reproductive technologies present some of the most difficult ethical dilemmas facing society today.
Unfortunately, ethical reflection lags behind medical technology in this area. Given the strong desire of most couples
to have a child to carry on their legacy, it is not surprising to see the lengths to which people will go to have a child
that has at least some of their genetic material. People's desires to have genetically related children will likely insure a
brisk business for practitioners of reproductive medicine and, as a result, there will be an ongoing need for ethical
discussion and decision making in this area.

Scott B. Rae, Th.M., Ph.D. is Associate Professor of Biblical Studies and Christian Ethics, Talbot Sc hool of Theology,
Biola University, La Mirada, California.

NOTES

1 Congregation for the Doctrine of the Faith, "Instruction on Respect for Human Life in Its Origin and on the Dignity
of Procreation," Origins 16:40 (19 March 1987): 704-5.
2 Ibid., 706.

3 For further information on Catholic teaching in this area, see Edward Collins Vacek, S.J., "Catholic Natural Law and

Reproductive Ethics," Journal of Medicine and Philosophy 17 (1992): 329-46.

4 Both the Code of Hammurabi (1792-1750 B.C.) and the Nuzi tablets (1520 B.C.) authorize surrogacy, and not only for

cases of barrenness. Thus surrogacy was not only widely practiced, but it was the subject of detailed legislation to
keep the practice within proper limits.
5 In the matter of Baby M, 537 A. 2d, 1249 (1988).

6 The statistics on the annual income of surrogates are a bit misleading since they record the income of women who

were selected as surrogates, but do not take into account the women who applied to be surrogates but were not
chosen. In a 1983 study by psychiatrist Philip Parker, he found that more than forty percent of the applicants to
provide surrogacy services were receiving some kind of government financial assistance. See "Motivation of
Surrogate Mothers: Initial Findings," American Journal of Psychiatry 140 (1983): 1.
7 Statement of staff psychologist Howard Adelman of Surrogate Mothering Ltd. in Philadelphia; cited in Gena Corea,

The Mother Machine (New York: Harper and Row, 1985), 229.
8 Cited in Corea, 245.

9 Cited in Corea, 214-15.

10 Daniel Callahan, "Surrogate Motherhood: A Bad Idea," New York Times, 20 January 1987, B21.

11 In Stanley v. Illinois, the Supreme Court stated that "the rights to conceive and to raise one's children have been

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deemed essential...basic civil rights of man...far more precious than property rights. It is cardinal with us that the
custody, care and nurture of the child reside first in the parents." 405 U.S. 650 (1971), at 651.

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