Christianity and assisted reproductive technologies: the search for moral and ethical foundations

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Abstract


The problems of assisted reproductive technologies (ART) continue to be the subject of both medical, philosophical and ethical, and theological discussions among representatives of different faiths. ART allow us to bring into this world those who are without the help of the latest technologies could not be among us in the situation when the natural way of coming is impossible. But for this medicine uses methods that are alien to the nature of the living and the nature of man as a biological species, in particular. And it should be noted that it is the moral and ethical norms rooted in the religious worldview that are under the greatest pressure from the constantly growing flow of changes in all spheres of life caused by the accelerating scientific and technical progress and especially by the rapid development of biotechnology and especially ART. We can single out the following problems of ART, which, one way or another, consider all confessions. These include, above all, an excess of the resulting embryos; surrogacy; interference with the «fate» of embryos using preimplantation genetic diagnosis (PGD); insufficient responsibility of medical staff and, as a result, the problem of «authenticity» of genetic material of patients using ART; the use of ART for single women and men, as well as transgender and non-binary people, etc.

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Assisted reproductive technologies (ART) allow us to bring into this world those who are in a different situation, without the help of the latest technologies, could not be among us where the natural way of coming is impossible. But for this medicine uses methods that are alien to the nature of the living and the nature of man as a biological species, in particular [10]. By the beginning of the 21st century, the development of biomedical technologies reached the stage that allows not only to provide medical assistance in overcoming diseases, but also to directly manage human life from its beginning to the earthly end. So, prenatal diagnosis of embryos (preimplantation genetic diagnosis - PGD) makes it possible to predict the parameters of the future life, and gene therapy to change these parameters. Therefore, the problems of ART continue to be the subject of both medical, philosophical and ethical, and theological discussions among representatives of different faiths. So, P. Yersild in 1982 gave a classification of theological points of view on IVF, without specifying them by confessions. He divided the views into three categories. The first was the opinions of those who found support for the idea of the «natural order» in the Bible. According to this idea, the natural way of childbearing and only it complies with divine laws, which should not be overthrown by such procedures as IVF. He attributed to the second category those who hold the opinion that the sacred texts do not testify about God as the designer of a static order, but about the God of history, who constantly encourages people to become «colleagues» in creating a more humane world. If medical science and technology allow childless couples to gain the blessed status of a parent, we should be glad that such achievements are possible, and also recognize that we fulfill the role given to us by God. The third category has united those whose theological orientation does not give any categorical «yes» or «no» in relation to «in vitro fertilization» (IVF), but raises questions about the proper priority of IVF. So, for example, the question «why do we have children?» able to determine the prerogatives of the Christian destination in relation to IVF. The formulation of such a question leads to the conclusion that the responsibility of parents to God is not concentrated in childbirth, but in raising children. Since the case of pregnancy is not important for the upbringing of children, and IVF creates serious ethical and moral problems, adoption should be a priority alternative to IVF. 2 (24) 2019 ФЕДЕРАЛЬНЫЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ The document entitled «The Basics of the Social Concept of the Russian Orthodox Church» [7] separates the concepts of «artificial insemination» and «extracorporeal fertilization». The first of them, according to the Concept, presented in the XXII chapter, considers the issue from a moral point of view, the second - in general. However, in the opinion of priest Alexy Knutov and Archpriest Igor Aksenov [1], in paragraph 4 of XXII chapter there is no sufficient degree of clarity required for the disclosure of issues relating to human life. However, in reality, the term «artificial insemination» in the Concept means not a phenomenon, but a completely specific method of intracorporal (intra-body) fertilization - artificial insemination (introduction of husband's sperm into the uterine cavity in an artificial way). Therefore, in the opinion of some clergymen, this paragraph in the XXII chapter of The Basics of the Social Concept of the ROC should be understood as follows: artificial insemination (AI), an artificial introduction of the germ cells of the husband into the womb, can be considered as acceptable means for integrity of the marriage union and does not differ in a fundamental way from the natural conception. The concept of IVF says the following: «Morally unacceptable from an Orthodox point of view are all varieties of in vitro (out-of-body) fertilization, involving the preparation, preservation and deliberate destruction of excess embryos». However, the Concept does not give a clear answer to the question whether the formation in vitro of a limited number of embryos (for example, two) is morally acceptable, followed by transplantation of all of them into the uterine cavity. Hegumen Artyukhin is sure that the risk of death of embryos transplanted into the uterus during IVF is higher than that of embryos resulting from natural conception. In his opinion (which probably expresses the opinion of the Council on Biomedical Ethics of the Moscow Patriarchate), embryo transfer to the womb is nothing more than a scientific experiment, and the price of the experiment is human life, because from the point of view of Orthodoxy, embryos are already «human». However, this view does not take into account that, according to modern research in the field of reproduction, at least 70 % of embryos in the conditions of natural conception cannot be implanted or die in the first days (weeks) due to genomic anomalies or violations of embryogenesis [4, 5]. The development of ART today, thanks to the PGD of embryos, reduces the percentage of genome breakdowns in embryos prepared for transfer to the uterus [4]. The Basics of the Social Concept of the ROC clearly set out the position of the ROC with regard to the manipulation of donation of germ cells and surrogate motherhood. Thus, the use of donor material, according to the Concept, violates the integrity of the person and the exclusiveness of marital relations, allowing the intrusion of a third party into them. The use of donor material undermines the foundations of family relationships, since it implies the presence, in addition to «social», also so-called «biological» parents of the child. «Surrogate motherhood», that is, the gestation of a fertilized egg by a woman who, after giving birth, returns the child to the «customers», is unnatural and morally unacceptable even in cases when it is done on a non-commercial basis. This technique involves the destruction of deep emotional and spiritual intimacy, which is established between the mother and baby already during pregnancy. The Roman Catholic Church adheres to the same position, for this Church the key question of the ethics of ART is the question of the status of a human embryo. Official documents of the Vatican emanating from the Pontifical Council for the Family or the Pontifical Academy for Life, state that from the moment of conception a human embryo, even if it consists of a fertilized egg, is zygote, possesses the same human dignity as any other human person [1, 12]. Cardinal Alfonso Lopez Trujillo, president of the Pontifical Council for the Family, in a programmatic article «Cloning: the disappearance of direct parenthood and the denial of the family» writes: «The human embryo, recognized on the basis that the human person is endowed with an organism for itself, has its own dignity and therefore deserves respect. This ‘dignity’ is not caused by any external additions, but is inherent in its existence, in and of itself. If people refuse to admit that an embryo has human dignity on the pretext that it does not have an actual consciousness, then the dignity of people who sleep or are in a coma should also not be recognized. If the dignity of the embryo is rejected, then the dignity of the child can also be denied» [12]. Due to the fact that ART is associated with the production of an excess of human embryos, some of which can then be destroyed, the Roman Catholic Church considers ethically unacceptable in vitro fertilization methods, cloning, and similar reproductive technologies associated with the production and death of human embryos. Of particular interest is the reaction of Protestantism to the development and implementation of ART. Due to the fact that Protestantism itself is a heterogeneous phenomenon, the range of its approaches is also quite wide. Thus, the «Social Position of the Protestant Churches of Russia», which was prepared by Russian Protestant denominations in accordance with the decision of the Advisory Council of the Heads of Protestant Churches in 2003, does not provide a detailed answer to the question of our interest. In the section «Manipulations with the birth of human life» we can see a more distinct position on the problem of surrogacy and donor conception. However the document does not give an answer if artificial insemination is possible with the husband’s sperm. Thus, conservative Mennonites completely deny such technologies, as, indeed, any fruits of scientific and technical progress, 14 ФЕДЕРАЛЬНЫЙ НАУЧНО-ПРАКТИЧЕСКИИ ЖУРНАЛ 2 (24) 2019 regarding the claims of man to the role of the Creator. Protestant liberals, on the contrary, in the development of biomedical technologies see a manifestation of the creative ability of a person given to him by the Almighty. Also, the attitude of Protestantism towards in vitro fertilization is not voiced. The entire analysis of the use of reproductive technologies comes down to the moral problem of family integrity and the violation of the divine plan for man. Conception and the birth of children is «one of the most natural results of family life, conceived and blessed by God» [1, 2, 11]. Artificial reproduction of people suggests a sensitive attitude to the value of human life. Accordingly, such procedures as in vitro fertilization «require a preliminary determination of the number of fertilized eggs, as well as moral issues related to deciding the fate of the remaining pre-embryos» [11, 14]. We do not see here a clear position and a clear answer -«it is possible» or «not allowed» - to use the IVF. Rather, it looks like some kind of warning for those who still ventured to get involved in a difficult, from a moral point of view, situation. In the past decade, liberal tendencies have gained massive popularity, leading to even greater separation of Protestant communities. The confrontation of conservative and liberal supporters of the bioethical problems of ART in Protestantism shows, as we see it, the growing ideological crisis. However, the most real problem for the Protestant churches is the ethical understanding of in vitro fertilization, which is closely related to the question of the moral and legal status of the embryo. Seventh-day Adventists rated the IVF method as a whole positive. They stressed that in many cases of infertility, the desire of married couples to have children can be realized only with the help of modern methods of medicine. Conscious of the importance of posing and understanding a large number of very difficult social and ethical issues arising from the practical use of artificial insemination methods, the authors of the «Concept of the Adventist International Medical Society» wrote the following: «The use of in vitro fertilization can be a great blessing for childless spouses, allowing them have a child who will be their child». Perhaps Adventists are one of the few who pay close attention to medical issues. Collaboration with medical organizations or establishing own Adventist medical centers is a must-have for social service in this branch of Protestantism. An aid to infertile couples is also an integral part of this ministry. «The continuation of the human race is part of Gods plan, and children are a blessing from the Lord», says Recommendations on artificial insemination, with reasoning references to the Bible. Childlessness is not a shame: no one should be forced to have children through (or without help) medical intervention. Religious ideas and the moral and ethical norms resulting from them, being by nature factor-forming in relation to human cultures, are determinants not only for the Christian world, but also for peoples professing Islam, Buddhism, Judaism or others who have local distribution, own religious views. It should be noted that it i s the moral and ethical norms rooted in the religious worldview are under the greatest pressure from the constantly increasing flow of changes in all spheres of life caused by the accelerating scientific and technological progress and especially by the rapid development of biotechnology and especially ART [11, 15]. We can single out the following problems of ART , which, one way or another, consider all confessions. These include, above all, an excess of the resulting embryos; surrogacy; interference with the «fate» of embryos using PGD; insufficient responsibility of me dical staff and, as a result, the problem of «au-thenticity» of genetic material of patients using ART; the use of ART for single women and men, as well as transgender and non-binary people. These problems and their joint discussion in the foreseeable future can become a natural platform, a zone for exchanging opinions and developing new convictions in an effort to create favorable socio-biological and universal moral attitudes for solving the continuation of life on earth in all its diversity of possibilities.

About the authors

L. P Kiyaschenko

Institute of Philosophy RAS

Email: сhemenko@mtu-net.ru

Doctor of Philosophy, Leading Researcher, Sector of Interdisciplinary Problems of Scientific and Technical Development

S. A Bronfman

I. M. Sechenov First Moscow State Medical University

Email: сhernenko@mtu-net.ru

Candidate of Medical Sciences, Senior Researcher at the Laboratory for the Development and Implementation of New Non-Drug Therapeutic Methods of the Research Center

F. G Maylenova

Institute of Philosophy RAS

Email: farida.mailenova@gmail.com

Doctor of Philosophy, Leading Researcher in the Humanitarian Expertise and Bioethics Sector

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