Catholics & IVF: the next big battleground?

For several years I have used a cartoon in my course on the ethics of reproductive technology that depicts protestors in front of a stem-cell research lab condemning those who work there as antilife. The protestors hold signs that read, "Baby Killer!" "It's Murder!" and "Butcher." Down the street at the abortion clinic, the workers are noting how quiet things have gotten at their facility since the stem-cell lab opened. After showing students the cartoon, I ask them to imagine that an in-vitro fertilization (IVF) clinic is substituted for the stem-cell facility. I ask students whether the cartoon still makes sense with the change. The point of the exercise is to get students to notice an important fact: vocal and strident critics of abortion and stem-cell research hardly ever make a fuss about IVF. They may criticize IVF, but they rarely do so with the same rhetorical passion that characterizes condemnations of abortion or stem-cell research. That may be about to change.

William Saletan of Slate magazine has argued, for example, that prolife advocates are "on a collision course with IVF" and predicts a nasty battle ahead. He notes that President George W. Bush's language about IVF has hardened over the past couple of years, and that the president's opposition to using embryos left over from IVF for stem-cell research, a position dramatically highlighted recently by his meeting with the so-called Snowflake families who have "adopted" IVF embryos, is likely to result in efforts to restrict or ban IVF. As Saletan puts the point, it's hard to see how critics of stem-cell research who refer to the destruction of embryos needed to derive embryonic stem cells as the "slaughter" of human beings "can go on tolerating the surplus creation, freezing, and disposal of millions of IVF embryos."

Although it is unlikely that the Bush administration will attempt to restrict or ban IVF, Saletan is right in thinking that some conservative prolife groups may. If a battle is brewing over IVF in this country, where are Catholics likely to stand in the coming fight? If the situation in Italy is any indication, the hierarchy may well support efforts to control or ban IVF. In Italy the church lent its support to passing a law that forbids genetic screening or freezing of embryos, and mandates that no more than three eggs can be fertilized and put into a uterus during an IVF attempt. When a referendum was held in June to repeal part of the law, Pope Benedict XVI expressed support for the law, and many church leaders urged people not to vote, a strategy designed to defeat the repeal that proved successful. (Only 26 percent of voters, not the required 50 percent took part.) Although the U.S. bishops are unlikely to lead the charge to pass similar legislation in this country, such an effort by Protestant fundamentalist or evangelical groups could well have the bishops' support.

What about the average person in the pew? Here the evidence is somewhat equivocal. Although it is hard to get good data on how Catholic laypeople regard IVF, there is much anecdotal and indirect evidence that Catholics embrace IVF as a means of overcoming infertility in roughly the same numbers as other Americans. Consider, for example, the study, Reproductive Genetic Testing: What America Thinks, released last December by the Genetics and Public Policy Center at Johns Hopkins University. Based on national surveys, focus groups, and interviews conducted between 2002 and 2004, the study is arguably the most comprehensive assessment of Americans' opinions about genetic technologies, including those that involve IVF. The results of the study suggest that Catholics strongly support IVF, at least in some circumstances.

For example, in the 2004 survey, approximately two-thirds of those questioned approved of the use of preimplantation genetic diagnosis (PGD) to screen IVF embryos for fatal childhood diseases. A similar proportion approved screening of embryos to identify those that would be an appropriate tissue match for donating blood or tissue to a sick sibling. Indeed, nearly 40 percent of the Catholics surveyed approved of using PGD to screen for the sex of a child. Perhaps even more interesting, the study investigated whether people's views about the status of the embryo correlated with their views about the acceptability of using PGD. Thus, those polled were asked to identify whether an embryo in a Petri dish had maximum, high, moderate, low, or no moral worth. Even for those who said that the in-vitro embryo had maximum moral status--a group that presumably includes most Catholics--52 percent approved using PGD to screen against a fatal childhood disease and 54 percent approved of screening for tissue matching.

Even if a large percentage of American Catholics endorses the use of IVF, of course, that fact would not be moral justification for its use. But, given the fact that magisterial teaching is quite clear about the immorality of IVF and PGD, how do we explain this apparent dichotomy between hierarchical teaching and Catholic opinion? One answer is surely that Catholic couples treasure the children that have been created through IVF and have a hard time seeing these children and the techniques that led to them as anything other than a blessing. A second answer, however, goes back to the point made by the thought experiment with the cartoon, namely, that the rhetoric condemning IVF has been mild compared to that condemning abortion or stem-cell research. To be sure, the American bishops have rejected IVF as morally illicit, but the bishops have not by and large condemned IVF in the same terms as they have condemned abortion and stem-cell research. Yet, if the embryo is a person from conception, then IVF, as it is practiced in this country where early embryos are routinely frozen or discarded or both, is essentially equivalent to abortion or stem-cell research.

The logic of the case is unassailable. If the embryo is a person from conception, then President Bush is right that there are no spare embryos in IVF centers, only persons needing to be adopted. The problem is that the logic of this position also leads to the view that discarding embryos as a routine part of a cycle of IVF is equivalent to killing an innocent child, and that infertile couples who conceive IVF embryos knowing that some will be discarded are complicit with evil. This is, of course, the point that Saletan makes in drawing attention to President Bush's meeting with the "Snowflake" families. For it is a very short step from saying (as a spokesperson for the Family Research Council did) that unwanted, frozen IVF embryos are "abandoned children," to saying that discarded IVF embryos are murdered children.

For many, the fact that defining conception as the threshold for personhood inevitably leads to the conclusion that persons who use IVF either commit grave evil or are complicit with grave evil, is problematic. According to this way of thinking, a position on embryo status that commits us to condemning infertile couples as killers is surely mistaken. And the fact that almost no one has been willing to condemn infertile couples in these terms suggests at least some uncertainty, even among those who insist that the embryo is a person from conception.

As Saletan suggests, though, all this may be about to change. If it does--if a war over IVF breaks out--the U.S. bishops are going to face a stark choice: either condemn IVF in the same (passionate) terms as abortion and stem-cell research or acknowledge that an IVF embryo does not have the same moral status as an implanted fetus. The first option has the great advantage of being consistent. It is also appealing because it abandons the untenable strategy of making moral pronouncements sotto voce. The problem with this option is that many conscientious people who have thought very carefully about embryo status see a fundamental difference between a developing embryo consisting of a couple of hundred cells and an implanted fetus that has the form and structure of human life. For example, bioethics commissions in England, Canada, and the United States that have studied embryo status have all recommended drawing the moral line at the development of the so-called primitive streak at about fourteen days, when twinning is no longer possible and the trajectory of individual development has begun. These commissions may be wrong, but for the bishops to insist that the in-vitro embryo and the implanted fetus are morally equivalent without providing a convincing rationale, or at least acknowledging that reasonable people may disagree about this, will almost certainly further erode respect for magisterial teaching with those Catholics who accept IVF as a legitimate, if not ideal, response to infertility. The second option has the advantage of avoiding these problems, but it has its own troubles, not least of which is that once you say that the early embryo is not a person, you have the burden of saying when the embryo becomes a person and why it should be treated with respect before that point. To be honest, those who question the personhood of the early embryo almost never take up this burden, and the failure to do so is deeply problematic. Among other things, this failure may lead to treating the in-vitro embryo as a kind of property that can be bought and sold online, as human gametes now are.

In the end, neither choice is particularly attractive. Stick with a clear but unconvincing position or change the position and open the door to potential abuse. If that sounds familiar, that's because it is. Think birth control redux.

The Gunner, John

Pity him here, his skull crushed by a tread--
beneath the mud pressed out, one intact jaw,
some teeth at ninety degrees, the scraps of a tongue--
Was he no more than this? No, this was a mask;
place it in a calm beneath the ground,
and when he takes it off he'll still be whole.

--Frederick Foote

Paul Lauritzen is director of the Program in Applied Ethics at John Carroll University in Cleveland.