Assisted Reproductive Technology: Progress or Peril?

1. Assisted Reproductive Technology: Progress or Peril? Ashley K. Fernandes, MD, PhD Wright State University School of Medicine, Dayton, Ohio Earl K. Fernandes, STD, Mdiv Mt. St. Mary’s Seminary, Cincinnati, Ohio Blessed are they who did not see, and yet believed. (John 20:29)

2. Purpose • To outline the science and philosophy behind a pro-life position on Assisted Reproductive Technology (ART) • To show that the philosophy behind the Catholic Church’s view is something reasonable • To answer some common objections to this view along the way

3. What This Talk Is • An acknowledgment of brotherly help! • A brief outline of the epidemiology and science of some assisted reproductive techniques (ARTs) • An articulation of the ethical and social problems involved in ART • A decidedly Catholic-Christian enterprise—no apologies! (except in the Greek sense) Dr. Fernandes Fr. Fernandes

4. What This Talk is NOT • An apology (except in the Greek sense!) • A defense of Christianity itself • An attempt to present all arguments in favor of, or against, ART • A “bashing” of the proponents or users of ART

5. Christ and the Apostles, Domitilla Catacombs, Rome (4th cent.)

6. In the Image of God “…is central to the identity of every man and woman. This identity consists in the capacity to live in truth and love…the need of truth and love as an essential dimension of the life of the person.” --John Paul II, Letter to Families (1994)

7. The Human Person • In his reflections on the family, John Paul II sees the family as a communio personarum, bound in love • The fundamental unit of value is the human person • But what is his nature?

8. The Human Person The Christian personalist model A person is an individual substance of a rational nature (persona est rationalis naturae individua substantia) A person is a being created in the image and likeness of God The positivist-empiricist model • ‘Extrapolations of science’s materialist premises produces a bioethics measured by the good of the body or the species, for that is all there is. Mind, soul, emotion, spirit—all are simply epiphenomena of mater…There is no reality beyond what we can touch, see, feel, or smell.’ --Edmund Pellegrino, describing the positivist-empiricist model

9. The Right to Truth and Love • Individualism • People are free to decide for themselves what to do with their bodies and themselves • Caring is non-interference with the desires of another • The obliteration of the person as one who thinks, acts, loves, and lives in community with another • Personalism • Freedom transcends choice (actus hominis) • Freedom is choosing the truth in love (communion) with/for self and another (actus humanus) • A person becomes (actualizes himself) what he was created to be when he chooses the good

10. The Relationship Between Faith and Reason • Are Faith and Reason Incompatible? • Does Reason Have Limits? • Can tenets of Faith legitimately contradict reason?

11. Epistemological Theories • Scientism: There are no valid forms of knowledge outside the scientific method; religion, metaphysics, theology etc. are generated by emotions, or biologic processes • Eclectisism: blending of different methods of reason, philosophy, theology without attention to internal coherence • Pragmatism: Religion is useful to humans, but not necessary; makes no claims on its origins • Nihilism/Marxism etc: Religion and spirituality, like human existence, are absurd or harmful

12. Fides et Ratio: A Unity of Knowledge in Christianity • “[The Christian notion of the Resurrection] is the reef upon which the link between faith and philosophy can break up, but it is also the reef beyond which the two can set forth upon the boundless ocean of truth. Here we see not only the border between reason and faith, but also the space where the two may meet.” • Fides et Ratio, Sect 21, 1998

13. “In an age when scientific developments attract and seduce with the possibilities they offer, it's more important than ever to educate our contemporaries' consciences so that science does not become the criteria for goodness… [Scientific investigation should be accompanied by] research into anthropology, philosophy and theology to give insight into man's own mystery, because no science can say who man is, where he comes from or where he is going… Man is not the fruit of chance or a bundle of convergences, determinisms or physical and chemical reactions…” Pope Benedict XVI, address to the Paris Academy of Sciences and the Pontifical Academy of Sciences, January 28, 2008

14. Science has a Purpose • “Thus science and technology require, for their own intrinsic meaning, an unconditional respect for the fundamental criteria of the moral law: that is to say, they must be at the service of the human person, of his inalienable rights and his true and integral good according to the design and will of God.” (DV , n. 2)

15. ART: The Science

16. The Infertility Crisis • Infertility is a real and growing problem in contemporary society. • 7.4% of married women of childbearing age are infertile; 2% had sought some kind of medical treatment (CDC, 2007) • 1/3 female-cause; 1/3 male cause; 1/3 both or unknown • Reasons: • Delayed age of marriage • Oligospermia or azoospermia in men • Ovulation disorders • Physical defects (blocked fallopian tubes, endometriosis) • Increased sexual activity (increased STDs and PID) • Undiagnosed STDs • Genetic factors

17. The Infertility Crisis • More than 3 million IVF babies have been born worldwide (56% in Europe) • Only 5% of US Catholics use some form of Natural Family Planning • Source: National Survey of Family Growth

18. Fertilization Techniques Fertilization Techniques: • Extra-Corporeal (outside the body) • IVF-ET • ICSI • ZIFT • Intra-Corporeal (inside the body) • GIFT • IUI/AI

19. Extracorporeal: IVF In Vitro Fertilization (IVF) • 1% of all live births in the US (doubled over decade) • 29% of IVF cycles led to a live birth; 18% of IVF pregnancies did not • Number of embryos transferred varies from country to country (e.g., UK/NZ/Australia: 2; Greece: 3) • ASRM: age-dependent (2-5), but no limit to # conceived

20. The Use of ART is Increasing Source: CDC website: http://www.cdc.gov/art/ART (accessed 5/2010)

21. Transfer of Embryos Source: CDC website: http://www.cdc.gov/art/ART (accessed 5/2010)

22. Extracorporeal: ICSI • Intracytoplasmic Sperm Injection • Used in 40% of IVF

23. Use of ICSI Source: CDC website: http://www.cdc.gov/art/ART (accessed 5/2010)

24. Intracorporeal: IUI/AI • Intrauterine Insemination/Artificial Insemination • Used for male factor, nondonor sperm, or unexplained infertility

25. GIFT (Intracorporeal) & ZIFT (Extracorporeal) • Gamete Intrafallopian Transfer • 25-35% success rate • Zygote Intrafallopian Transfer • 65% success rate

26. Ooplasmic Transfer and SCNT • Ooplasmic Transfer: combines sperm, egg, and cytoplasm from a third party donor egg to create an embryo • Human Reproductive Cloning • Broad consensus against this (for now) in US, BUT…

27. Somatic Cell Nuclear Transfer (“Therapeutic Cloning”) & its link to ESR

28. Other Important Terms • Surrogate Motherhood (Gestational surrogate vs Surrogate Mother) • Pre-implantation Diagnosis • Heterologous vs Homologous Embryo Transfer • Homologous: The sperm and egg originate from spouses. • Heterologous: The sperm or egg is from a donor who is not a spouse

29. ART: The Philosophical Arguments "You will know the truth, and the truth will make you free." (Jn 8:32)

30. 1. The Embryo Question

32. 2. The Right to Parenthood • NO: But, that doesn’t mean that facilitating one’s desires isn’t a good thing • NO: People should accept what they have; not all desires should be fulfilled if they may lead to ethical problems • YES: A negative right—they have a right not to be interfered with • YES: A positive right—someone has a duty to facilitate a person’s desire to have children

33. 3. The Social Impact of ART • Multiple gestations have quadrupled over the last 25 years • preterm labor and birth • PIH (3 x the risk) • Anemia (2 x the risk) • birth defects (2 x the risk) • miscarriage • twin-to-twin transfusion syndrome • abnormal amounts of amniotic fluid • cesarean delivery • postpartum hemorrhage

34. 3. The Social Impact of ART • Gamete donation and Surrogacy: Exploitation? Marketing?

35. 3. The Social Impact of ART • Access • What restrictions to access are justified?

37. 3. The Social Impact of ART • The Frozen Embryo Question • Embryo Adoption • 200, 000+ in the US • Embryonic Stem Cell Research—does ART lead to a “positive good?” Or, does ESR “resolve” an ethical dilemma?

39. 4. Eugenics and Pre-Implantation Diagnosis Fewer children being born with cystic fibrosis Globe and Mail, Friday, October 28, 2005 The number of children born with cystic fibrosis has fallen sharply since Canadian researchers discovered the genetic cause of the debilitating disease in 1989. New research, published in The Journal of Pediatrics, shows that one in 3,608 babies is born with CF, down from one in 2,714 before a genetic test existed. "Our hypothesis is that pregnancies are being terminated," Dr. Mary Corey, a senior scientist at the Hospital for Sick Children in Toronto, said in an interview.

40. 5. The Technological Imperative ‘Without tools [man] is nothing; with them he is all.’ ---Thomas Carlyle (1841)

41. Summary • The Catholic Church insists on both the primacy and dignity of the human person • There is no contradiction between faith and reason • Given the rapid pace of technological advancement, there are at least some prima faciae reasons for critiquing ART.

43. Donum Vitae (1987)Technology at the Service of the Person • Those techniques are acceptable in which one simply has the transfer of the egg into a more favorable place in which to encounter the sperm which is deposited after a normal sexual union, without other medical interventions. • E.g., LTOT

44. Donum Vitae:Pastoral Note • Every child which comes into the world must in any case be accepted as a living gift of the Divine Goodness and must be brought up with love.

46. 21st Century Questions • 1. Why does the Church care about MY choices and MY freedom? • 2. Doesn’t the Church encourage children? Isn’t ART is very “pro-life,” and “pro-family?” • 3. Why is the Catholic Church always AGAINST everything?

47. Dignitas Personae (2008): Fundamental Principles • 1. “The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life” (n. 4).

48. All Human Life is Sacred • Every human embryo should be treated as a person with an immutable nature. • DP asserts that every human embryo is a person with dignity. • An embryo should not be treated as an object for experimentation, research, or even to “fulfill” the wishes of prospective parents.

49. 1. Why does the Church care so much about MY choices and MY freedom? Because authentic freedom involves not just choosing—but choosing the good. IVF establishes the “domination of technology over the origin and destiny of the human person” (n. 17).

50. Dignitas Personae (2008): Fundamental Principles 2. “The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman.  Procreation which is truly responsible vis-à-vis the child to be born must be the fruit of marriage” (n. 6).