Biotech Babies

It is probably natural to want a child of one's own. Is it also good? Perhaps if it is truly natural, in accord with our created nature, it must also be good. But the seemingly innocent desire to have "a child of one's own," combined with the high-tech possibilities of modern medicine and the ever-present pursuit of commercial gain, has fashioned a world in which we regularly create moral conundrums that are beyond our ability not only to solve but even to name. The things we are willing to do tell a story—a story about the point of having children.Gilbert Meilaender

Consider the following cases, all roughly adapted from "real life," chosen almost at random:

1. A woman unable to have a child "of her own" had her ovum fertilized with her husband's sperm in the laboratory. The resulting embryo was then implanted in the womb of the woman's mother, who, having carried the pregnancy to term, gave birth to her own "grandchild."

2. A husband and wife who thought they wanted a child "of their own" contracted for the conception of a child who would be conceived from sperm and ovum that came from anonymous donors and who would then be gestated in the womb of a hired surrogate. Shortly before the child was born, the husband and wife who had wanted this child divorced. A judge felt compelled to rule that the baby girl actually had no legal parents at all.

3. A woman undergoing infertility treatment in order to have a child "of her own" conceived triplets. For medical reasons she was advised that it would be safest if she were to undergo "fetal reduction"—that is, reduce by abortion the number of fetuses she was carrying to one. She did, but weeks later, having undergone amniocentesis, she learned that the one remaining fetus had a genetic anomaly. She therefore aborted that fetus as well.

4. An infertile married couple desiring a child "of their own" underwent in vitro fertilization (IVF) and conceived a child. Four-and-a-half months into the pregnancy they learned from amniocentesis that the child they had wanted so badly and worked so hard to make had Down's syndrome. Having learned that, they decided to abort.

5. An infertile married couple sought in vitro fertilization in hopes of producing a child "of their own." Before undergoing the procedure, the couple signed an agreement saying that the resulting embryos could not be used without the consent of both parties and that, should they divorce, ownership of the embryos would be decided either in a property settlement or through a court decision. Nine attempts to implant embryos fertilized in the laboratory failed to result in a pregnancy that could be carried to term. Four embryos were implanted in a surrogate, the woman's older sister, but that procedure also failed. Shortly thereafter the couple divorced and the woman sought a court order giving her sole custody of the embryos so that she could try again to have a child "of her own." Given the prior agreement the couple had made, the court ruled that the woman could not do this without the consent of her former husband.

6. A young woman about to undergo chemotherapy for leukemia but hoping nevertheless some day to have a child "of her own" had her ova harvested and fertilized with donor sperm before treatment—and the resulting embryos frozen. After she died of leukemia at age 28, her parents sought a surrogate who would agree to gestate the embryos. In this search they used the Internet and an appearance on the Oprah Winfrey show, intending that their son and daughter-in-law would raise the child if the pregnancy could be successfully carried to term.

7. A 63-year-old woman, wanting a child "of her own" had implanted into her hormonally primed uterus an embryo made in the laboratory from her husband's sperm and an ovum from a younger donor. She then completed the pregnancy and gave birth to a child.

Such cases could be multiplied almost without end, and we may sometimes find it hard to remember or believe that the first "test tube baby" was born only 20 years ago, in 1978. Two decades later we live in a world in which a woman can give birth to her own "grandchild"; in which a child can have as many as five "parents" (the donors of sperm and ovum, the surrogate who carries the child during pregnancy, and the two "rearing parents"); in which people can "have children" posthumously; in which parents can go to great trouble and expense to conceive a child whom they then abort if prenatal diagnosis shows that the child is "defective" in some way; in which quite soon it may be possible to give birth to identical twins born years apart; and in which it may soon be possible for a woman without ovaries to receive an ovary transplant from an aborted fetus, making that fetus the biological mother of her child. And none of this comes cheaply. A recent report of the New York State Task Force on Life and the Law notes that "[c]onservative estimates place the cost of a successful delivery via IVF at more than $40,000."

Taken together these cases display the story we have begun to tell each other about the meaning of children. The story line is, roughly, as follows: Because having children is something many people want for their lives to be full and complete, and because it is such a fundamental aspect of human life, we ought to use our skills to help them achieve that desired fulfillment. Indeed, having children is an entitlement to which there are few limits. Of course, we ought not exercise this right in a way that directly harms children, but in many cases, after all, the children would not even exist were it not for the use of new reproductive technologies. If the suffering that infertility brings can be relieved, and if children are not harmed, then high-tech reproductive medicine is a good thing. This is the story that, more and more, we tell ourselves in this society.

Is there a different image of the child, an image that tells a different story about what it means to have children? Christians should hope so, and they should search for it. The poet Galway Kinnell, in a wonderful poem titled "After Making Love We Hear Footsteps," provides such an image: The child is, he writes, a "blessing love gives again into our arms." What makes this a better image than that emerging from the examples with which I began? What story of the meaning of a child underlies this image? One way to think about such questions is to reflect upon the desire to have "a child of one's own." This desire, which is simultaneously quite natural and problematic, needs examination.

THE STORY CHRISTIANS TELL

Christians have a story to tell, a story we regularly teach to our children—of an infertile woman who deeply desired a child of her own, how her wish was granted, and what she then did. It is the story of Hannah, her husband Elkanah, and their son Samuel (1 Sam. 1-2). Why did Hannah want a child of her own? In part, it seems, it was because she suffered the scorn of Peninnah, Elkanah's other wife, who had children. But that only presses the question a step further. Why should this be an occasion for scorn? What is so important about having a child? Why do people care so deeply?

Sometimes today, when we ask such questions, answers of the following sort come back: "I desire the experience of pregnancy and childbirth." "I want the experience of child rearing." "Having a child is an important part of defining who I am." No doubt there is some truth about us buried in such answers. There are deep psychological, and even biological, imperatives at work in the impulse to give birth. But such answers, which make of the child a means of meeting our needs, cannot be satisfactory. To think that way is already to begin to think of children as products made to satisfy some of our desires. And, of course, if and when the product turns out not really to satisfy us, we may be hard pressed to muster the kind of unconditional love children require if they are to flourish. That we do, nevertheless, often learn to love our children unconditionally suggests that the experience of child rearing teaches us about something more important than our own identity.

There are, though, deeper and better reasons for having children. We would make a little moral progress were we to say, "I want a child because I want a link to future generations." Surely that was part of Hannah's desire. In her world the link between the generations may have had greater economic importance than it now does, but even in our world it is of considerable human significance. We are not angels or free spirits who can choose to be whatever we wish; rather, we are embodied creatures, located in a particular time and place. In part, at least, it is lines of kinship and descent that identify us, even though we never choose our particular location. To learn to affirm and give thanks for our place in the world is part of growing up—and, more important, part of learning how to receive the mysterious gift of life. It is, therefore, quite natural that we should want to give life even as we have received it. That takes us some considerable way beyond the narcissism of wanting a child simply as a means to fulfilling ourselves.

But it does not take us quite far enough, for it continues to think simply of a child of my own, still part of the project by which I make my way in the world. We get much closer to a satisfactory understanding if we think of a child of our own. Elkanah is already a father, but he and Hannah together—as one flesh—are not parents. Even in so ancient a story as this one, there are hints that this too is part of the reason for wanting a child. We are specifically told that Elkanah loved Hannah. He himself tells her that she is more to him than ten sons. Their love-giving has not yet been life-giving, however. It is natural that they should want a child, for that child would be the sign that the love by which they give themselves to each other is creative and fruitful.

CHRISTIANS UNDERSTAND THE
DEEP DESIRE TO HAVE CHILDREN.
BUT WE MUST ALSO CONSTANTLY REMIND OURSELVES THAT CHILDREN ARE NOT OUR POSSESSION;
THEY ARE GIFTS FROM GOD

Indeed, this last step—in which they seek a child not of his own or her own but of their own—begins to take them still further. It presses almost toward elimination of that little word own. In the passion of sexual love a man and woman step out of themselves, so to speak, and give themselves to each other. That is why we speak of sexual ecstasy—a word that means precisely standing outside oneself. No matter how much they may desire a child as the fruit of their love, in the act of love itself they must set aside all such projects and desires. They are not any longer making a baby of their own. They are giving themselves in love. And the child, if a child is conceived, is not then the product of their willed creation. The child is a gift and a mystery, springing from their embrace—a blessing love gives into their arms. They could and should, if they think the matter through, quite rightly say that they had received this child as a gift of God, as the biblical writer says of Hannah: "The LORD remembered her."

Samuel is neither Elkanah's "own," nor Hannah's "own," nor even "their own." He is "God's own"—asked of the Lord and given by the Lord. He is not, therefore, simply Hannah's or Elkanah's to hold onto; rather, he must be offered back to God, as Hannah does. Lent to the Lord, for as long as he lives.

Christians, then, do not underestimate the sheer human significance of biological ties. We understand the deep desire to have children. But we must also constantly remind ourselves that children are not our possession; they are gifts of God. They exist not simply to fulfill us but as the sign that, by God's continued blessing, self-giving love is creative and fruitful. And what if the Lord does not "remember" us as he remembered Hannah? That is reason for sadness, but it is not reason to take up the "project" of making a child. The couple who cannot have children may adopt children who need a home and parents, or they may find other ways in which their union can, as a union, turn outward and be fruitful.

LIVING OUR STORY

If this is how Christians understand the meaning of the presence of children, how shall we evaluate the vast array of new reproductive technologies—not, for the moment, as a matter of public policy, but simply as possibilities within our own lives?

The first thing to note is that many of the new techniques involve parties other than husband and wife in the reproductive process. (This is usually the case because the couple is infertile. There are also circumstances, however, in which fertile couples might turn to assisted reproduction techniques—for example, if one of the spouses carries a serious recessive genetic disorder. The moral issues remain essentially the same, however.) Artificial insemination and in vitro fertilization very often involve sperm and egg from anonymous donors, and there is an irony here that we should not ignore. If what infertile couples want is a child "of their own" in the genetic sense, techniques using donated gametes will not provide it. They are, in a sense, deceiving themselves. In the name of having a child of their own, they fail, in fact, to honor the importance of biological connection, of kinship and descent.

Imagine a case in which a married couple seeks donor insemination because of the husband's infertility. Someone might say, of course, that the child whom they produce is at least genetically related to the mother—it is her own, even if not also his own in the same sense. And for Christians that is exactly the cause for worry. The child is to be theirs, not hers or his. The deliberate and willed asymmetry of relation—so unlike the mutual asymmetry that exists in adoption—is precisely the problem. This child is no longer the fruit of their one-flesh union. Its genetic connection to the mother or the opportunity it provides for her to experience pregnancy and childbirth are her individual projects. Even if her husband also desires that connection and wants her to have the experience, he shares this project only in thought, not in the body. The child cannot be the fruit of an embrace in which husband and wife step outside themselves, their aims and projects, and receive a child as a gift, a sign that the Lord has remembered them.

If we imagine the opposite sort of case—in which the ovum rather than the sperm is donated, or, even more, in which the child is gestated by a surrogate—the same concerns will be in play. In addition, however, something disturbing happens to the relation of mother and child. Fatherhood, paternity, has always been a somewhat detached and "intellectualized" relation during pregnancy. Paternity is not obvious. It can be disputed. Fathers must think themselves into relation with the child in the womb. Not so with maternity. A pregnant woman need not think herself into relation with the child—she experiences that bond constantly. But once more than one "mother"—genetic and gestational—has become part of the process, maternity also becomes a disputable fact, and we have the court cases all around us to prove it.

Moreover, Christian spouses who set foot on what was once a back road but has now become an interstate highway of assisted reproduction should know how difficult it may be to find an exit ramp once they have begun this journey. They are not really seeking to correct a medical problem but to bypass it. To bypass it in order to satisfy a deep and very important desire—to have a child. But if it is the couple's desire that is being treated, we need to remember that they may not simply desire a child. They probably also desire, for example, a healthy child. And new reproductive technologies more and more commonly involve genetic diagnosis of the newly formed embryo before it is implanted in the uterus. The pressure to discard embryos who do not meet desired specifications—and to try again—may be almost impossible to resist. Spouses who undertake this journey are likely to have invested many dollars and years—not to say tears—along the way. It is only human to want the best possible result. Understandable as that is, however, it is no longer quite the same kind of unconditional love for a child who is not our product but God's gift.

I can think of one possible exception to the claim that Christians ought not participate in new reproductive technologies that involve sperm or ovum from third parties. Rather than using either sperm donation alone or egg donation alone, a couple might "adopt," gestate, and rear a donated embryo. In such a case, unlike sperm or egg donation, the child will not be genetically linked to either parent. Although this very fact may cause concern to some who think of reproductive medicine as providing new ways to get a child "of one's own," from the Christian perspective it is preferable. We might think of it as adoption that occurs before rather than after the child's birth. The relation of husband and wife to the child is symmetrical, and they do not deceive themselves into supposing that this is in any genetic sense a child of their own.

Unfortunately—at least in our society at the present time—embryo donation is not likely really to be analogous to adoption. There are already, in fact, a few clinics that sell embryos to infertile couples who want a child. Sometimes the embryos are custom made—allowing prospective parents to choose a combination of sperm and egg donors that best satisfies them. Other times the embryos are extras that were made for an infertile couple who achieved a pregnancy without using them. Christians could, of course, understand themselves to be rescuing such children—who as spare embryos can only be implanted in a womb, used for research, frozen and stored indefinitely, or discarded. But if we are looking for needy children to rescue, they are, alas, all around us in our foster-care system. Prebirth embryo adoption is not likely to signal similar attempts at rescue. It is far more likely to be one more way of exercising quality control, of finding the child whom we want—rather than loving the child we have been given.

In short, many of the new reproductive technologies will involve the use of third parties. In doing so, they break the connection between love-giving and life-giving in marriage. That is not just a minor nuance, for it is this connection that teaches us to think of the child as a gift, that keeps us from thinking of children as our project, as existing for the sake of satisfying our desires. It is no accident, then, that these technologies usually encourage genetic diagnosis—whether before implantation or after—of the "fitness" of the embryo or the fetus. If we understand the child as our project, if we accept that kind of responsibility, then we may inevitably find that "quality control" seems like an obvious—perhaps even imperative—part of the process. This is a journey we ought not even begin.

But what if no third parties are involved? There are certainly some circumstances in which an infertile couple might make use of new reproductive technologies while using only their own sperm and ova. Women may take drugs to influence ovulation. This may be combined with assisted insemination—when the sperm are placed directly in the vagina, cervix, or even uterus—if the man's sperm count is low. Either or both of these may often be part of an in vitro fertilization procedure in which both sperm and ovum are externalized and fertilization takes place in the laboratory. It is even possible now, within the IVF procedure, to inject a single sperm into the ovum.

Even when no third parties are involved there are serious moral concerns in the use of new reproductive technologies. The couple will be encouraged to "screen" the embryos formed in the laboratory, to consider whether a particular embryo is really the child they desire. If more embryos are produced than are implanted in the woman's uterus, they will have to ask themselves what should be done with the extras. Even apart from any IVF procedure, the use of ovulation-enhancing drugs alone means that the possibility of multiple fetuses—triplets and even higher-order multiple births—is greatly increased, and such pregnancies involve significant risks for the children conceived. They are much more likely to be born prematurely and to have low birthweight, and they may suffer lifelong complications as a result. Multiple fetuses also mean that the couple will have to deal with recommendations of "fetal reduction." In general, and even entirely apart from the use of donated sperm or eggs, it becomes increasingly difficult to think of the child as a gift and not a product. These are simply some of the hazards of the road they are traveling.

When we remember again the number of needy children who go unadopted precisely because of their needs, when we consider the degree to which new reproductive technologies have—in a very short time—begun to teach our society to think of reproduction as a right to which everyone is entitled, when we ponder the implications of these technologies for our society's understanding of children, we must ask whether Christians should not call a halt—at least for themselves. We do not have a story that teaches us to think of children as our entitlement or our possession. Indeed, the story we tell goes even beyond that of Hannah, Elkanah, and Samuel. For knowing as we do that God has already provided The Child, we can free ourselves of the feverish need to have a child of our own, whatever the cost. Perhaps the greatest service we can perform for our own children and for the world into which they will be born is to live in such a way that we remind ourselves and others that each child is indeed not our product, our project, or our possession, but a "blessing" that "love gives again into our arms."

Gilbert Meilaender holds the board of directors chair in Christian ethics at Valparaiso University. A second edition of his book The Taste for the Other: The Social and Ethical Thought of C. S. Lewis has just been released by Eerdmans.

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