How should Christians respond to reproductive technologies like IVF and PGD? Ellen Painter Dollar is a mother, blogger, and author of the excellent new book No Easy Choice: A Story of Disability, Parenthood, and Faith in an Age of Advanced Reproduction. In it, she describes why she decided to use preimplantation genetic diagnosis (PGD) and the moral questions it raises for people of faith.
What is PGD, and why did you decide to try it?
PGD, or preimplantation genetic diagnosis, is in vitro fertilization with an added step. In normal IVF, a sperm and egg are joined in a lab and then placed back in the mother. In PGD, there’s an additional step where the fertilized egg is tested in the lab for a particular genetic mutation, such as one causing a genetic disorder. Because I have a genetic bone disorder (osteogenesis imperfecta or OI), we used PGD to try to have a child who would not inherit the condition. Our oldest child had inherited OI, and there was a 50 percent chance that any child I have would inherit.
The book blends your personal story with some of the larger questions raised by PGD. What are those questions?
There are a lot of questions around suffering, particularly the suffering that results from physical disease and illnesses. For Christians, the question of suffering is theological. Was it my duty as a parent to ensure that my children would not suffer from this disorder, or was suffering something we should welcome as teaching us something important? Another set of questions is around how we as a society welcome children, particularly children with disabilities. Do technologies that screen embryos for disabilities devalue people who have those disabilities? And in a larger sense, do reproductive technologies tempt us to try to control the kind of children we get?
Also, fertility medicine is a very lucrative specialty that’s governed by a sort of consumerist mindset. Patients want to achieve success—pregnancy—most efficiently and get the most for their money. That raises questions about stewardship and what technologies to use for what purposes.
The final big area, of course, is around human embryos and how they are manipulated in reproductive technology, and whether that’s appropriate or not.
Can you explain that?
Well, when people go through IVF, there are often extra embryos left in a freezer, and parents need to decide what to do with those. And then there are other questions around evaluating embryos based on one trait. In my case, we were evaluating embryos regarding whether they had this one trait, OI. Are we reducing what it means to be a human being, and failing to treat the whole person with dignity and respect, by making these kinds of judgments based on one question?
What did you decide about PGD?
We knew we wanted more children, but we were overwhelmed by the idea of having another fragile child. Our [oldest] daughter had six broken bones between her second and fourth birthdays, which happened to be the same time we were making these decisions. We chose to do one cycle of PGD and it failed. I did not get pregnant. During that time I began to grapple with the ethical, moral, and theological questions raised by this technology. We decided not to proceed. That was partly because of these questions, but there was also an emotional component—we were worn out—and a financial component. So it was a combination of factors that made us decide not to use PGD again.
One of the issues raised in your book is that there are very few restrictions on fertility medicine in US law.
Basically, fertility clinics in the US can do whatever they are technically able to do, if people can pay for it. There is a professional association that puts out voluntary guidelines for doctors, such as how many embryos should be transferred in a single IVF cycle, with the goal of reducing multiple pregnancies. But many doctors admit that they don’t always follow those guidelines because they, as well as their patients, feel that they need to maximize their chances of achieving a pregnancy, and that more embryos will increase the chance.
So our guidelines are voluntary and there is no regulation by the government. On the other hand, in Britain, a government authority oversees use of reproductive technologies and makes guidelines about what clinics can and cannot do.
Several years ago, a California clinic offered to allow parents to use PGD select their child’s eye or hair color. The clinic shut down the program after a public outcry. But legally, there was no reason they could not use the technology that way. And my guess is that eventually, clinics will begin offering these types of services, unless we draw some lines about proper and improper uses of fertility medicine. That California clinic, by the way, still has a thriving program offering PGD for gender selection, which they advertise to immigrants from cultures in which male offspring are favored.
As a blogger about reproductive ethics, you have encountered some controversy about the abortion question. You said you find that when Christians address reproductive technology, they tend to get stuck about whatever they believe about abortion.
Right. A pro-choice person might worry that regulating fertility medicine could infringe on reproductive rights, and a pro-life person might think that anything that involves manipulating embryos is automatically wrong and should be avoided. But these views don’t address other important questions, like how much control parents should have over their offspring, or questions about money or how we value kids with disabilities.
The other thing that happens is that focusing only on abortion really limits our ability to talk to each other, because people’s views on abortion are so divisive. If we frame the debate in that way, we’ll just be shouting past each other. The people who will suffer are the parents sitting in the pews who are trying to make important decisions about reproduction, and they’re not finding support and resources within their faith communities. Churches need to be talking about this as reproductive technologies become more ubiquitous and sophisticated.