Bioethics Comes to Church

Each of us will make at least one bioethical decision in our lifetime. Many of us will be forced to make quite a few more.

Yes, you read that correctly.

Bioethics is not a far-off field of study in the ivory tower of academics—where physicians, scientists, ethicists and theologians grapple with concepts in isolation from the real world. No, bioethics is personal, yet none of us know exactly when we will face our critical decision in the context of personal health care options.

Consider the pastor who contacted us at The Center for Bioethics & Human Dignity a few years ago regarding a situation in his congregation. A young couple had shared with him the pain and grief of their struggle with infertility. By the time the pastor contacted us at CBHD, they had gone through in vitro fertilization—a procedure in which eggs are fertilized in a petri dish (typically using the egg and sperm from the couple) and then implanted in the womb. Despite several rounds of IVF, the couple was still unable to get pregnant.

CBHD staff offered the pastor some ways to frame a conversation about the ethical and theological dimensions of the situation. One evening, before the pastor had the opportunity to speak with them, the couple shared an update in their small group. God had answered their prayers: The wife’s mother had offered to act as surrogate for her future grandchildren. And the IVF procedure was a success: She was pregnant with their twins.

At that point, the only further counsel that CBHD staff could impart was that every child should be welcomed in life and celebrated, no matter how he/she is conceived. Unfortunately, a number of ethical lines had been crossed in the process that may have future medical, emotional and social consequences.

We live in a medically, scientifically and technologically sophisticated age. And so we must begin thinking theologically and biblically about ethics in general and bioethics in particular long before we face crucial points of decision.

Deep longings meet tough questions

Bioethics addresses a vast array of medical and technological issues. No one can be an expert in all of them, including the CBHD research staff. Some of the most common issues people in our congregations are facing relate to unexpected prenatal diagnosis, infertility and end-of-life decision making, whether due to old age, illness or tragedy.

Science and technology continue to advance at a rapid pace, offering us previously unavailable medical options. Many advances are beneficial and provide wonderful opportunities for those seeking care; however, we still need to recognize that decisions we make related to our care carry ethical concerns. This realization can be paralyzing. Rather than making us fearful, however, the awareness of such concerns can inspire us to consider ways to live more faithfully.

Using the opening example as a guide, let’s consider some of the concerns raised by the alternative ways we pursue having children.

The longing to have a child of one’s own is a deep and God-given desire. When faced with the possibility of not having that desire fulfilled, there can be a sense of loss coupled with intense questioning of God’s purposes. It is OK to wrestle with questions of why, and grieving can be healthy and restorative. However, should the believer pursue a child of one’s own at any cost?

How much less stressful it would be for a couple to discuss this before reaching the emotionally laden juncture of infertility. And churches might help lead the way by opening up ethical conversations when there is little emotion attached to them. (A good book for discussing reproductive technologies is Outside the Womb, by Scott Rae and D. Joy Riley).

Consider all the choices faced by the couple mentioned above, before they even mentioned it to their pastor.

1. The process of IVF carries with it a certain amount of risk to the woman’s health for a procedure that is not essential to her physical health. Her ovaries are stimulated first, using a drug that can have harsh consequences for a small percentage of women. This doesn’t even account for the retrieval procedure itself, which carries its own risks.
2. Once a doctor retrieves the eggs, they are combined with the sperm outside of the womb in a petri dish. IVF is a lucrative business, and many fertility doctors want to ensure success. Typically, this means that several embryos are created in order to increase the chance of pregnancy.
3. At this point, many use prenatal genetic diagnosis to test for genetic abnormalities, possibly discarding any embryos that test positively. The doctor usually chooses two or three of the most-healthy looking ones to be implanted in one cycle of IVF, although single embryo transfer is increasing in practice.
4. Each IVF cycle is expensive, and most fail. “Surplus” embryos are often frozen for later use, or discarded. Freezing and thawing the embryos introduces additional risk, with a meaningful percentage that do not survive. In one sense, we are creating life to take life. Some embryos remain frozen indefinitely; an estimated 650,000 or more embryos are currently frozen, with that number increasing every year.¹

And then there are the increased ethical choices surrounding surrogacy. Being a surrogate for someone who cannot have a child might seem altruistic. However, it has the potential to cause asymmetrical social relationship bonds and unnecessary tension, especially within a family.

There are an increasing number of people going to other countries to hire a surrogate, because of the reduced cost. In international surrogacy, poor women are often acting as the surrogate, to help their families financially. They are not always paid what they are initially promised and far less than what the contracting parent(s) pay to the agency. At times there is difficulty bringing the child back to the parents’ home country.

In some cases, when a child is born with a disability, the contracting couple has tried to force the surrogate to terminate the pregnancy or even has abandoned the baby.

Health, suffering and human flourishing

Again, the desire to have a child is God-given. But should believers pursue the fulfillment of this desire at any and all cost?

For that matter, should a believer always choose to protect his or her own health, regardless of cost or risk? Or do whatever it takes to avoid mortality? We need to ask ourselves: Just because we can do something, should we? When faced with such situations, how do we live faithfully and with hope?

Increasingly, many associate health with human flourishing. Indeed, the World Health Organization’s very broad definition of health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Yet health and human flourishing are not synonymous. A person can be in excellent health and unsatisfied in life. Someone else may be suffering a great deal, even nearing death, and find that they are flourishing remarkably well.

Health is a good gift from God, among many of His good gifts. It is not, however, the highest good, especially not for the believer. A presupposition of Christian ethics is that God is the greatest good, or summum bonum, and this is the starting point for placing the rest of life in its proper perspective.

In his 2013 plenary address at the Center’s summer bioethics conference, Dr. Allen Verhey noted that there is a moral risk to making health the summum bonum (and assigning messianic hopes to medicine), such that in this cult of health, “hospitals and exercise facilities are the temples, and doctors and dieticians are the priests.”

When faced with suffering, it is a very human response to desire relief by any means available. However, we are intended to flourish not despite suffering, ambiguity and vulnerability, but in and through them.

This does not mean that we do not pursue a healthy lifestyle or avoid medical interventions. It means that sometimes we may sacrifice health for a greater good or choose to not pursue a medical intervention that is morally questionable. It also means that we accept our finitude and learn when enough medical intervention is enough. Otherwise, as Dr. Verhey puts it, “Health can be a very demanding idol.”

Don’t navigate bioethical issues alone

With so many complicated issues, where does the Christian begin? Most bioethical questions do not have one-for-one answers in Scripture. Still, the Bible has much to offer. In fact, the church is well positioned for helping people think about life, flourishing and applying wisdom to complicated medical situations.

First, recognize the importance of a robust theological anthropology—where we develop an understanding of what it means to be human and our relationship to God and others. If you are a pastor, teach these theological concepts to your congregation, connecting them to bioethical examples of how we can live faithfully. One suggested resource is Theological Anthropology: A guide for the perplexed, by Marc Cortez.²

Second, facilitate conversations to help church members recognize that when they face a medical decision, there is much more at stake. They must also wrestle with theological considerations and issues of Christian faithfulness and ethics.

Third, in complicated medical situations, do not make decisions in isolation. Seek out resources that will help you know the moral and ethical concerns. Some therapies may be pursued in more ethical ways or at least in ways more consistent with specific Christian values, such as the IVF example in this article.

At the very least, make medical decisions in Christian community. Most hospitals have trained chaplains to help in such situations; there may be doctors in your church who have an understanding of bioethics; and CBHD is here to help navigate specific medical situations as well.

It is important for us to remember that we live in a fallen world, and all of us are going to experience the result of this in some aspect of our lives. Some of us will not be able to have a child of our own, others will face cancer, but our bodies have a telos, a purpose, outside of this life. We have hope and a God we can trust, who is drawing all things toward His good future.